management

conditions

St Peter’s Vets Ltd has surgeries in Petersfield, Horndean and Liss in Hampshire. The company has 13 veterinary surgeons, who along with nursing and reception staff provide a 24 hour a day service 365 days of the year.

Tristan Shanks

Allergies

An allergy is an abnormal immune reaction to an otherwise harmless substance - a pollen, for example - that is termed an allergen. Like all animals, cats can (and do!) suffer from allergies, but unlike humans, most allergic diseases in cats cause skin problems.

A cat's immune system has a number of different modes, or arms. One of these utilises a special kind of antibody called IgE, and a chemical called histamine, to help fight off internal parasites. However, it sometimes make a mistake and overreacts to the wrong things - that's what an allergy is. IgE detects and responds to the presence of a foreign protein, and tells the mast cells to release histamine, which causes itching, swelling and inflammation. This then sensitises the area to IgE even more, so a negative spiral develops.

Any cat may develop an allergy, but they are most commonly diagnosed for the first time in young adults. It's also important to realise that a cat cannot become allergic to something the first time they're exposed to it - it takes a while for their system to develop an excessive response to any new chemical they come into contact with, either natural or artificial.

It depends, of course, on the allergy in question! The most common feline allergic condition is Flea Allergic Dermatitis (FAD), where the cat become sensitive to flea saliva, but there are many, many other possibilities, including responses to pollen, dust mites, food, or washing materials. In cats, we generally recognise three common presentations of allergies. The most common of all is Allergic Dermatitis, or Allergic Skin Disease. This can be caused by any type of allergen (yes, even food allergies!) and mainly causes itching, self trauma, and a thing called Miliary Dermatitis - where small lumps form inside the skin, often with scabs on top. Other possible presentations, however, include Allergic Rhinitis (runny noses and snuffling, often caused by dust or pollen allergies); and Contact Dermatitis, where a specific patch of skin becomes sore and inflamed due to local contact (with, for example, a detergent or washing powder).

Well, telling that your cat has an allergy is pretty straightforward (inflamed, itchy patches or noses are pretty diagnostic!). However, determining exactly what the cause is can be much harder. We'll usually try to rule out Flea Allergies first, because they're so much more common than other types, by starting a very strict flea control programme, and perhaps using a short term medication (like a steroid) to damp down the itchiness. If that isn't sufficient, we'll investigate other options, either by allergen exclusion (avoid the suspicious substance, for example, changing to a hydrolysed protein diet that cannot cause allergic reactions to rule out a food allergy), or direct testing (with blood tests for IgE levels, and/or skin prick tests for histamine release sensitivity).

Allergies in cats can be very challenging to manage effectively. The ideal management technique is to exclude the allergens from the cat's diet and environment that they're sensitive to - for example, excellent and strict flea control in cats with FAD. However, this isn't always practical, so other techniques may also be needed. Immunotherapy (a type of vaccine given to desensitise the immune system) isn't widely used in cats, but there are now labs who can supply the appropriate vaccines; however, drug therapy is often required. Antihistamines are quite variable in how effective they are - some cats respond really well, but for most, it's pretty hit and miss - and often have marked side effects (they are essentially sedatives!). Steroids (as injections, tablets, creams or sprays) are often used, but if used in the long term, the side effects to tend to shorten lifespan. In some very severe allergies, a drug like cyclosporine may be needed to reduce the cat's immune response. In most cases, however, a balanced management programme incorporating multiple different strategies is needed to keep them comfortable.

Cat bite abscesses

A Cat Bite Abscess, or CBA, is a common result of cats fighting. Cats' mouths and claws contain a range of unpleasant bacteria, and when fighting they insert these bugs under the skin of their adversary. As the bacteria grow, they form a pouch of dead and dying tissue, bacteria and white blood cells - pus. This pus-filled pocket is an abscess.

As the name suggests, a CBA is most commonly due to a bite from another cat - because cat teeth are long and pointed, and easily penetrate the skin, leaving bacteria behind. Because the teeth are so sharp, and cats heal so well, often the skin will close over and heal, leaving infection inside. The bacteria attack the local cells, and the immune system fights back, building up pus inside a cavity under the skin.

As the abscess grows, it becomes painful, however, the majority of the symptoms are due to the infection. Cats with a CBA are often lethargic, off their food, and may have a temperature. They'll often have increased thirst, and may sometimes vomit as well. The site of the abscess, meanwhile, will be painful, swollen and hot. Eventually, it will burst, and thick cream, yellow or cream pus, often mixed with blood, will ooze out.

The most important factor in managing a CBA is to drain it - antibiotics alone are unlikely to resolve the abscess, the dead tissue needs to be out. The normal way to achieve this is for the vet to lance the abscess with a large-gauge needle to a scalpel blade, and then wash out the cavity. Normally, once the abscess has burst or been drained, the cat will start to feel better almost immediately; however, it may be appropriate to use painkillers or anti-inflammatories and antibiotics to encourage it to resolve faster.

Only by preventing cats from fighting - and cats who go outside will, occasionally, fight. However, neutering cats will often reduce their aggression and therefore reduce the risk of a fight, and thus a CBA.

"Cat Flu" isn't actually a single disease - it can in fact be caused by four different disease organisms. The two most common are Feline Herpes Virus (FHV, also known as Feline Rhinotracheitis) and Feline Calicivirus (FCV). The third cause is less common, and is the Bordetella bacterium, the same as causes Kennel Cough in dogs. The final condition is Feline Chlamydia (Chlamydophila felis infection); unlike in most species, this bacterium does not usually cause intestinal upsets or reproductive disease, and rarely causes any symptoms except in combination with another infectious agent.

Any cat can become infected! In general, young kittens, very old, or ill cats are at most risk of severe disease, however. The disease organisms are easily transmitted from cat to cat by droplets in the air (especially from sneezing), and some can remain viable and infective for a prolonged period. Many cats also become carriers for Feline Herpes Virus, as even after the symptoms have apparently resolved, the virus will still be dormant in their bodies (mainly in nerve ganglia). If the cat becomes ill or stressed in future, the virus will reactivate and may cause disease, or be shed to infect other cats. Chlamydia is most common in large colonies of cats, and in these situations, any of the organisms will spread like wildfire through the cat population.

The main symptoms of Cat Flu are common to all four infections - runny nose, sneezing, lethargy, loss of appetite and a fever. In addition, Bordetella and Chlamydia often cause coughing; and both Herpes Virus and Chlamydia both cause sore, runny eyes and sometimes corneal ulcers. Calicivirus can lead to ulceration of the mouth and throat, and may result in severe systemic disease that can even be life-threatening.

In most cases, the clinical signs are diagnostic, and determining which organism is causing them isn't important. If for any reason it is important to distinguish between them, swabs from the eyes, nose and throat can be taken and sent away to a specialist lab who will grow the bacteria and isolate the viruses.

There is no specific treatment for Herpes Virus or Calicivirus infection; however, antibiotics (against secondary infections and/or Bordetella and Chlamydia) are frequently prescribed, along with anti-inflammatory drugs (to reduce the fever and make the cat more comfortable). Sometimes, mucolytic drugs (to soften the mucus in their noses and help them to breathe) may be used as well. In severe infections, intensive care nursing, intravenous fluids and even interferon (to stimulate the immune system) may be needed. In most cases, however, good quality home nursing is more appropriate than hospitalisation. It is important to encourage ill cats to drink (for example, with running water, or by moistening their gums to stimulate thirst) and eat (with a bunged up nose, cats are often reluctant to eat because they can't smell the food - so strong-smelling foods such as fish, warmed, and hand fed, are often the best solution).

Feline Herpes Virus and Calicivirus can both be prevented by vaccination, and are present in the normal annual boosters your cat should get. Although vaccination doesn't always stop the cat from carrying the viruses, it does mean that it is very unlikely for them to develop disease, or spread them. It is possible to vaccinate against Chlamydia, but this isn't normally necessary except in very large colonies of cats.

The FeLV virus is relatively common in unvaccinated cats (perhaps as many as 8% of cats carrying it). When a cat is infected (by bites, shared feed bowls, litter trays or even mutual grooming), the virus starts to attack the white blood cells. The cat's immune system will usually stop this rapid replication, but eventually the immune system itself is damaged, and stops working properly. In addition, the virus can trigger infected cells to become cancerous, causing leukaemia, lymphoma and (occasionally) sarcomas.

In the early stages of the disease, there are usually no symptoms - only when the immune system has been severely damaged, months or years after infection, do symptoms become visible. Immunosuppressive disease (i.e. disease caused by collapse of the immune system) may present in a range of different forms, but often include runny noses, sore eyes, persistent diarrhoea, sores in the mouth or gums, chronic skin or ear infections, or an unexplained fever or weight loss. In all cases, minor low-grade infections develop rapidly and may even become life-threatening. Neoplastic Disease (due to the development of virus-induced cancers) typically cause weight loss, obvious masses (e.g. swollen glands), diarrhoea, or anaemia. Sometimes, there may also be neurological signs (wobbliness or even seizures) if a tumour forms in the nervous system.

There is no cure for the disease. In the case of a cat who is incubating the disease but has not yet developed symptoms, it is really important to isolate them from at-risk cats - ideally by keeping them alone as indoor cats. This will also reduce their exposure to other diseases that may take advantage of their weakened immune system. The use of human anti-AIDS drugs may slow down the development of disease, but these drugs are difficult to dose safely in cats, and will not clear the virus completely.

FLUTD

FLUTD, or Feline Lower Urinary Tract Disorder, is the commonest cause of "cystitis" in cats. However, it is not in most cases associated with infection, and may be best described as a response of the cat to external stimuli.

The main cause of FLUTD is stress. Cats do not cope with stressful situations well, and one way they respond is by developing symptoms of cystitis. Stressful events for a cat may be obvious, such as rehoming, moving to a new house, new people visiting the house, or fighting with other cats. However, in many cases, the stressor is much more subtle - seeing a strange cat through the window, a change in household routine, or even moving the furniture. Additional risk factors include insufficient water intake, the formation of crystals in the urine (typically due to diet), or unwillingness to use the litter tray (for example, because it is dirty or there aren't enough for the number of cats).

All cats are potentially at risk of FLUTD, but some seem to cope better with stress than others. In general, the condition is most common in young and middle-aged adults (in cats over 8 years of age, by comparison, bacterial infections become increasingly common causes of cystitis symptoms). Obesity is also an important risk factor; and neutered tomcats are at the highest risk of developing an obstruction ("blocked bladder").

Straining to pass urine, pain or discomfort when urinating, and the passage of frequent, very small amounts. Often, urine when passed is bloodstained. Sometimes, the urethra (the tube carrying urine from the bladder to the outside world) becomes obstructed with debris or microcrystals. These cats (usually tomcats, most often neutered) are unable to urinate at all and will be in severe distress - this is an EMERGENCY that needs immediate veterinary attention.

It is the most common cause of cystitis, and in a young cat presenting with these symptoms, the most likely diagnosis. Other conditions (such as bacterial infections or bladder stones) can usually be ruled out with a urine test.

The best way of managing FLUTD is to resolve, or manage, the underlying stress. If it isn't something that can be reversed, the use of Feliway pheromone products is invaluable, and sometimes prescription medications to reduce anxiety. Meanwhile, the condition itself can usually be managed with pain relief, increased water intake (for example, feeding a wet diet), and sometimes glycosaminoglycan supplements. In the case of a cat with a blocked bladder, hospitalisation is urgently required; the vets will pass a urinary catheter to gently flush away the obstruction and to ensure the cat can urinate properly before going home.

The best way to prevent FLUTD is to address the risk factors (keep your cat at a healthy weight, feed wet food, in high-risk cats consider a urinary diet) and be alert for possible causes of stress - acting to relieve them as early as possible.

HCM

HCM occurs when the muscle in the cat's heart becomes excessively thickened. This might sound a good thing - a thick strong heart should mean a more efficient heart - but in HCM this process proceeds so far that the heart, although very powerful, is unable to fill with blood properly, resulting in abnormal blood flow, blood clot formation, and ultimately heart failure. There are two well recognised underlying causes of HCM - a genetic mutation and hyperthyroidism.

Hyperthyroidism may occur in any older cat, and often results in HCM. The genetic disease is most common in Maine Coon cats, although it has also been recognised in some Shorthaired breeds and Persians, among others. The genetic condition usually presents in young to middle-aged adult cats, and toms are thought to be at an increased risk.

In most cases, the initial symptom will sudden-onset heart failure or thromboembolic (blood clot) disease. Symptoms of heart failure in cats include exercise intolerance, difficulty breathing, collapse, pale gums, weak pulses, and even sudden death. Blood clots are more common, and may lead to sudden onset acutely painful paralysis (usually of the hindlimbs), a stroke (causing abnormal behaviour, blindness or paralysis), or a pulmonary embolism (rare, usually causing severe distress, difficulty in breathing and sudden death).

There is a blood test that is a useful screening test for heart disease in cats, but the only way to diagnose HCM is with an ultrasound scan of the heart (echocardiography). A heart scan like this can also assess how likely blood clots are in the near future, as micro-clots are visible as "smoke" in the left atrium of the heart.

There is a licensed medication (diltiazem) for HCM, which is designed to allow the heart muscle to relax, so the chambers can fill more effectively with blood. In addition, it is increasingly seen as good practice to prescribe certain blood-thinners to cats with HCM, to reduce the risk of blood clots forming,

Unfortunately, there is no way to prevent the genetic disease except by not breeding from known carriers. Good control of thyroxine levels in cats with hyperthyroidism will, however, usually prevent them from going on to develop HCM.

Hyperthyroidism

In most cases, it is due to a (benign) tumour in the thyroid gland. This tumour makes thyroxine, but does not respond to the signals from the brain telling it to stop when it has made enough, so thyroxine levels continually rise. Thyroxine controls the cat's metabolic rate, so an excess of thyroxine increases their basal metabolic rate, causing psychological and physiological hyperactivity.

A simple blood test will diagnose abnormally high levels of thyroxine in most cats. Occasionally, the levels appear falsely normal because of another illness (sick euthyroid syndrome), and the hyperthyroidism cannot be diagnosed until the other disease (e.g. kidney failure) has been treated.

There are 4 treatment options. The simplest is with diet - a special low iodine diet is given. The thyroid needs iodine to make thyroxine, so by limiting iodine, you limit production. This only works if the cat eats only the special food, without any treats, snacks or live prey. More commonly, we would use certain medications (carbimazole or its derivatives) - daily or twice daily tablets are very effective at controlling the condition in most cats. The condition can be managed medically, but for a "cure", the cat will need to undergo surgery - once the cat has been stabilised with diet or medication, we would remove the overactive thyroid gland. If this isn't an option, there is also a more modern approach, using Radioactive Iodine Treatment - the cat goes to a veterinary referral hospital where they can be given nuclear medicine treatment to destroy the hyperactive thyroid gland.

Chronic Kidney Disease

CKD, also known as Chronic Renal Failure or Kidney failure, is a progressive loss of kidney function - sadly, it is very common in cats. A cat's kidneys play a vital role in filtering waste products and toxins out of their blood; they also control the production of red blood cells (to carry oxygen) and help to regulate blood pressure.

The kidneys have a reserve capacity (the "functional reserve") of about 60%. Throughout life, some of the nephrons (the actual filtering tubes) will be damaged or lost, due to disease, injury or (most commonly) old age and overwork. Eventually, so many have been damaged that the kidney's function is impaired - we call this Chronic Kidney Disease, to distinguish it from Acute disease where an injury, shock or poisoning has destroyed or damaged large amounts of the kidney tissue in a single event.

Typically, symptoms of CKD develop gradually and insidiously. The usual signs are weight loss, increased thirst and increased urination. As waste products and toxins build up in the bloodstream, a strong metallic smell and ulceration of the mouth may develop, followed by dehydration, seizures, collapse and then death. Other possible effects of kidney failure include anaemia (pale gums and difficulty catching their breath) and high blood pressure, which can cause blindness or strokes. Many affected cats also have unusually low blood potassium levels, causing muscle weakness - typically, a drooping head carriage.

The most common way to diagnose kidney failure is with a blood test - increased amounts of wastes such as urea and creatinine can easily be detected, as can low red blood cell counts in anaemia. Urine tests are also useful, as the cat's diseased kidneys cannot concentrate their urine as much as in a healthy cat, plus they also tend to leak protein. Tests of blood pressure are also very important to determine whether eye and brain damage are likely.

There is no cure for CKD in cats (kidney transplants are technically possible, but are banned in the UK). However, the disease can usually be managed with appropriate diet, free access to water and medication. A cat with kidney failure requires a diet with the minimum QUANTITY of high QUALITY protein, low phosphate levels and high potassium levels. This is usually best provided with a specific renal diet, but if a cat will not eat it, a phosphate binding agent and supplementary potassium can be added to their normal diet. Free access to water will help to combat dehydration, and medications such as ACE inhibitors will reduce protein loss through the kidneys and help to stabilise blood pressure. If the cat's blood pressure is dangerously high, other drugs such as amlodipine may be needed to reduce it to a safe range.

Pancreatitis

Inflammation of the pancreas in the cat's abdomen is a remarkably common condition, and if mild may not result in any apparent symptoms. However, severe cases are serious and even potentially life-threatening.

The pancreas has two functions - producing pancreatic juice to help digest food, and producing hormones (such as insulin) to manage blood sugar levels. In pancreatitis, the pancreas becomes inflamed - either because of injury, a tumour, infection or an inflammatory disease. Cats are most prone to Chronic Pancreatitis; this occurs when there is a relatively mild original injury (in fact, we don't usually ever find out what it was), that causes the gland to leak pancreatic juice. This starts to digest the inside of the gland, causing a little more injury, causing more leakage, and so on. This often grumbles on for weeks or months, with no obvious symptoms, but may eventually become severe enough to be apparent.

They tend to be very vague and intermittent, making chronic pancreatitis hard to diagnose. Most commonly, weight loss, depression, lethargy, and reduced appetite, occasionally causing intermittent vomiting. Sometimes, the damage will become so severe that Acute Pancreatitis develops, with profuse vomiting, complete anorexia, jaundice, severe abdominal pain, dehydration and collapse.

In Acute Pancreatitis, hospitalisation, intravenous fluids, and assisted feeding (typically with a feeding tube) are required. Chronic Pancreatitis, however, usually has to be managed, with a highly digestible but low-fat diet, pain relief, and sometimes anti-inflammatory medication.

Toxoplasmosis

Toxoplasma gondii is a protozoan parasite (like an amoeba) of cats. It rarely causes disease in cats, but is potentially dangerous to any other animal that comes into contact with cat faeces, including humans.

The parasites live in the cat and lay eggs (or oocysts) which are passed out in the faeces. These are then eaten by rodents, sheep, dogs or people who handle cat faeces without sufficient hygiene! In this intermediate host, the parasites usually form cysts in the muscles, where they lie dormant until a cat eats the host (not terribly likely in the case of a human, but the parasite doesn't know that), when that cat becomes infected.

In the cat, usually nothing more than mild, transient diarrhoea. If the cat is pregnant when she becomes infected for the first time, her kittens may be severely disabled, or aborted. In other animals, symptoms are usually mild (fever, loss of appetite, lethargy) until their immune system clears the parasites. However, if they are pregnant, there is a strong possibility they will lose their puppy, lamb, kit - or, in humans, their baby. In any animal, if their immune system is weakened by another disease, there is the possibility of more severe disease affecting any organ system, especially the brain. In addition, we now know that that parasite acts to make mice and rats less afraid of cats (to increase the chances that they will be eaten), and some researchers claim that Toxoplasma infection in humans increases the risk of depression and risk-taking behaviour.

Preventing cats from contracting the parasite requires preventing them from hunting, or catching fleas. To protect other animals and humans, avoiding contact with cat faeces is the best and most effective method, although there is a vaccine for use in sheep. There is no significant risk from handling cats (even if they are carrying Toxo) while pregnant, as long as good hygiene procedures are maintained (in other words, wash your hands thoroughly!).

Diet

Cats, unlike dogs or people, are obligate carnivores - this means that they have a biological requirement for a meat diet. It is neither possible nor safe to formulate a vegan or vegetarian diet for a cat! However, just feeding them meat alone isn't sufficient either - they need a properly balanced diet, suited to their specific needs.

Like all animals, cats have specific requirements for water, the three major nutrients (protein, fat and carbohydrate), and micronutrients (such as iron, salts and vitamins). Creating a balanced diet can be tricky, because cats are adapted not to eat meat and vegetables (like us), but whole animals - meat, bone and internal organs. Of course, you could probably feed a cat perfectly healthily on a diet of whole mice, but most people are unwilling to try this! So in this guide, we'll look at each of the major nutrient groups, and briefly outline a cat's requirements.

(1) Water. All animals need water - a loss of only 15% of body water is usually fatal. Cats often don't seem to drink much, but that's usually because they are getting all the water they need from their food (wet food, for example, is usually 75% water!). In general, we assume that a cat needs roughly 50mls of water per day per kg, but a healthy intake may be a little lower, especially in cooler weather.

(2) Energy. All animals need energy to allow them to move and do things, and also to keep their basic metabolic systems running. Inadequate energy in the diet results in weight loss (as the cat uses its reserves to stay alive) and eventually starvation. Cats can get energy from protein, fat or carbohydrate, and usually need between 65 and 70 kcal (calories) per kg of body weight. However, most diets actually have too much energy in them, which is why so many cats are overweight or obese! The energy requirement will also vary according to a number of factors, such as age (growing kittens need more, old cats usually less), activity (the more they do, the more energy they need), gender (male animals usually need more than females, and neutered animals need less than entire ones). Pregnancy and lactation (milk production) also mean higher energy requirements. Overall, the best solution is usually to work out the rough amount the cat needs, feed them, and then adjust it depending on whether they are gaining or losing weight.

(3) Protein. Cats require much more protein in their diet than dogs, or humans - an adult cat's daily diet should usually include at least 26% protein. However, the total amount of protein isn't the only factor you need to take into account - you also need to note the protein quality. While dogs and humans can make some amino acids (the building blocks of proteins) relatively easily from other (which is why although there are 23 amino acids, only 11 are deemed "essential"), cats find this much harder. They require much higher levels of arginine, tyrosine and methionine than we do, for example, and unlike us cannot manufacture taurine at all. These amino acids are found predominantly (and in the case of taurine, exclusively) in animals - not in plants.

(4) Fat. Fat provides energy, but also certain vitamins (the "fat soluble" vitamins, A, D, E and K). In addition, it's the part of the diet that has the most impact on palatability and tastiness - and we all know how fussy cats can be! In general, a diet that is too low in fat will be rejected, unless extra carbohydrates are used to bulk it out and increase flavour.

(5) Carbohydrate. Cats do not actually need sugars and starches in their diet (there's very little sugar in a mouse!) - we add them to incorporate a cheap and easy source of energy. That said, there's nothing wrong with feeding carbs, as long as you remember that all they're doing is providing calories. However, adult cats cannot digest lactose (milk sugar) and should NOT be fed milk - it can give them diarrhoea. Likewise, unlike humans, cats do not need much (if any) dietary fibre, but about 5% is probably beneficial.

(6) Minerals and Vitamins. A cat's mineral requirements (for iron, phosphorus etc.) are similar to ours. However, in keeping with their strict meat-only lifestyle, cats require certain vitamins that are only found in animals, such as A, D and B3. These need to be in exactly the right ratio though, as an excess can cause disease. Growing kittens in particular need large amounts of calcium to form their bones - this is not found in meat alone, which is why it needs to be supplemented in the diet unless you're feeding whole animals.

The formulation of the diet is almost as important as its composition; in general, we can feed wetter diets or drier ones. There are advantages and disadvantages each way. A dry diet is better for their teeth (as it tends to scrape them clean, reducing dental problems compared with wet foods) but a wet food provides more water and is usually tastier, which is better in cats who are prone to bladder stones, or those with fussy appetites.

Of course, cats are individuals, and at certain times in their life, they may require a different balance of nutrients. For example, a pregnant cat or growing kitten requires more energy, and more protein, than a healthy adult. Likewise, a cat whose kittens are still drinking her milk benefits from more carbohydrate, to make the milk sugars. You also need to factor in any disease conditions - cats with kidney disease, for example, need a very different diet to healthy cats. Overall, however, these guidelines are pretty accurate for 90% of cats, 90% of the time.

The simplest and easiest way to feed a cat a fully balanced and healthy diet is to feed a reputable commercial diet (wet or dry). However, if you want to make up a homemade diet, that's fine - but we STRONGLY advise that you get advice from a fully qualified feline nutritionist. Talk to one of our vets, and we'll be able to direct you to someone!

Flea Control

Fleas are the biggest cause of skin disease for UK pets - even now, with so many great products on the market, they're still present living on cats across the country! There are two reasons they're hard to get rid of - firstly, they can jump from cat to dog to rabbit to human to cat and so evade us; and second, 95% of the fleas aren't living on the animal, but hiding away in your home, waiting for their chance.

(1) Herbal and homeopathic remedies. Herbal flea remedies are notoriously unreliable - what works in one cat fails completely in another. Unfortunately, we cannot recommend homeopathic remedies, as there is no evidence that they are effective against fleas.

(2) Over-the-Counter Flea Drops and Powders. There are a wide range available, at very cheap prices. However, remember that, with medicines as with everything else, you get what you pay for. Over-the-counter products from pet shops or supermarkets are unlikely to be as effective as prescription-only or vet/pharmacist only products - not least because these often do not need to prove their effectiveness. There have also been MAJOR problems in recent years with unscrupulous manufacturers rebranding dog medications for cats, with fatal effects - many dog flea treatments contain permethrin which, while safe in canines, is fatal to cats.

(3) Prescription Flea Spot-Ons. There are a lot of different spot-on medications, containing different ingredients, but they all work by killing the fleas. The most common contain fipronil, selamectin or imidacloprid, but there are others as well. These medications have to prove their effectiveness before being given a license; however, remember that many aren't waterproof and will wash out if you give your cat a bath or even if they spend a lot of time outdoors in wet undergrowth. On the other hand, these are often effective against other parasites, such as ticks or mange mites. Of course, you can only get these from, or with a prescription from, your vet.

(4) Flea Tablets. There are a number of different brands, and different active ingredients available now; these have the advantage that they cannot be washed off. They do still need to be repeated periodically though - like all medications, they won't last for ever! Some over-the-counter tablets only last for 24 hours, whereas some of the prescription-only products last a whole month.

(5) Medicated Collars. Available as a prescription-only medication, these are effective for up to eight months, and also treat and repel ticks. The collars also contain a safety-catch so the cat cannot become hung-up or injured by - instead, the collar will open allowing the cat to escape.

(6) Environmental Control Medications. Some flea products contain ingredients called Insect Growth Regulators, that effectively put the fleas on the pill so they only lay non-viable eggs. Others contain ingredients that directly act to kill flea larvae in the environment. These are invaluable for preventing a household infestation, but may not completely control one that is already established (or at least, not quickly). These are most commonly given either mixed in with a spot-on; or as an injection.

(7) Environmental insecticides. These can be sprayed onto soft furnishings throughout the home to kill larvae and eggs. Bear in mind that, although generally effective, you need to follow the label instructions, as these can be toxic to cats if you don't allow enough airing time after application! In addition, flea pupae are immune to any form of chemical warfare we can practically employ!

(8) Vacuuming. Yes, the humble vacuumed cleaner is your secret weapon in the war on fleas! It will suck up eggs, and the flea-droppings that the larvae feed on, but more importantly, it will stimulate the pupae to hatch, releasing new hungry adults. In this state, they an easily be killed with an insecticide spray!

No one medication or intervention will control a severe infestation - instead, you'll need to attack them on several fronts, usually with an adult-killing medication, and environmental control spray or medication, and spotless hygiene in the home. If you need advice, feel free to call us!

Giving medications

It's all very well for us vets to say "give these tablets twice a day, next patient please!" - but how easy do you actually find it to give medication to your cat? In this brief guide, we'll look at some common medications, and easy tricks to help you get them into or onto your pet!

Different routes of medication are used for different conditions in cats; however, there are a few common ones we'll look at here. Remember, whatever the medication is, always follow the directions that came with it. If you can't read something, or can't understand them, or if they seem wrong - don't make it up, call and ask us!

(1) Tablets. Tablets or capsules are the most common forms of medication, and can be among the trickiest to administer. In some cases, they can be broken up and hidden in food (typically inside a chunk of wet food or hidden in their bowl) - however, make sure that breaking the tablet won't alter how well it works because some medications are inactivated, or even become dangerous, if broken. Remember too, that cats are excellent at discovering and rejecting medications! Many people find it easier to actively "pill" their cat. To do this, it's useful to have a proper pill-popper or tablet-giver, but not essential. Sit your cat down with their head pointing towards you (you may need an assistant!) and open their lower jaw gently with one finger. Then, using the pill-popper, pop the tablet on the back of their tongue and close their mouth before they spit it out. Hold their mouth shut until they lick their lips, at which point they should have swallowed it. Sometimes, giving a little trickle of water between their lips can encourage them to swallow but DON'T give too much.

(2) Oral Liquids. As many cats are VERY hard to tablet, these are increasingly popular. They are usually given with or on food, and can just be measured out into or into the food. Usually, it's easier to administer them in a strong-smelling or particularly tasty type of food, but most are designed to taste quite nice by themselves. If you have to give an oral liquid in the absence of food, or the cat won't eat the food with it on, the trick is to use a syringe (obviously without a needle on) and gently inject it between their teeth. The best technique is to sit them down, close their lips with one hand and then insert the syringe through the gap between their cheek teeth, then GENTLY syringe it into them (not too fast or they might choke on it). Once its in their mouth, hold their mouth closed and rub their throat until they swallow.

(3) Spot-Ons. Most commonly used for flea, tick and other parasite treatments, spot-on medications are increasingly being used. They should be applied to the back of the cat's neck (i.e. where they can't reach it to lick!). Part the hairs carefully, and then deposit the liquid on the skin directly. If the volume of liquid is too great, split the dose between 2 or more sites. Make sure it's completely dries before you pet the cat or allow any other pets to lick them!

(4) Ear Cleaners. Used to clean the ears, so don't confuse these with ear drops (containing medication for treating ear diseases). To apply an ear cleaner, have the cat sitting or standing upright, and lift their ear up (which will straighten the ear canal). Then apply a suitable amount of cleaner directly into the canal but DO NOT force the nozzle into the ear, or you may damage the sensitive structures inside. Instead, insert the tip of the nozzle just into the canal before squeezing. After filling the canal with the cleaner, find the firm "trumpet" of cartilage below the ear, and give it a good massage - you'll usually get a lovely squishing sound as you move the cleaner around inside the ear. Then use a cloth or cotton wool to wipe away the liquid and dirt that comes back out of the ear (again, DON'T stick anything down inside). Beware afterwards - most cats will shake their heads violently, spraying the room with cleaner and liquid ear wax, so probably better do this away from any soft furnishings!

(6) Shampoos and Washes. There are all sorts of different shampoos and washes, for many different conditions. Each needs to be made up in a different concentration and left on for a different amount of time. Basically, READ THE LABEL before you start! In general, however, you need to wet the cat all over (which is unlikely to be popular, but remember, it's for their own good!). Then apply the shampoo (remember, you may need to wear gloves for some) and lather it up. Allow the cat to stand for the required amount of time before rinsing thoroughly with lots and lots of fresh water, and then allow them to dry off naturally (towelling and using hairdriers are usually a bad idea, for various reasons).

(7) Eye Drops. Medicating a sore eye can be really difficult - cats don't like you poking at their eyes (understandably), and the muscle that closes the eyelids (orbicularis oculi, if you're interested) is, for its size, the strongest in the whole body. The trick with eye drops is not to try to apply them directly to the surface of the eye (the cat's blink reflex is often too fast for that!) but into the lower eyelid. So, allow them to stand or sit upright, and then with one hand gently CLOSE the affected eye. Use your thumb to carefully open just he lower eyelid, so it stick out, and apply the required quantity of drops onto the INSIDE of the lower eyelid. Then, allow the eye to close, and the drops will be transported onto the surface of the eye. Easy!

Giving medications can be tough, but it's usually straightforward once you know how! If your cat really resents it or you're finding it really hard, don't struggle on and risk getting scratched or bitten, or hurting them. Instead, give us a call and we'll be able to show you how (or suggest a different option if even we can't get them to cooperate!).

Hairballs

Cats frequently develop hairballs, or "furballs", which occur mainly because when they groom themselves, they accidentally swallow some of the hair. In most cases, hairballs are retched up again (which is a bit disgusting, but not dangerous). However, in some cases a large hairball may cause an intestinal obstruction or constipation. Occasionally, they are so severe that the cat requires surgery to remove them.

Most cats probably develop hairballs from time to time; however, cats with long coats are at the highest risk, because the longer hairs are more likely to matt together in their intestines. Some cats also have more problems with processing hairballs because of other underlying diseases, such as Feline Dysautonomia (Key-Gaskall Syndrome), or Megacolon.

(1) Grooming. Most hairballs form when cats grooms themselves, particularly when they're removing dead hair. By giving them a helping hand, you reduce the amount of hair for them to swallow. A dematting tool such as a "furminator" is invaluable in gently grooming and removing excess dead hair.

(2) Laxatives. Although not suitable for most cats, most of the time, in cats with a particular predilection to hairballs, periodic use of cat-specific hairball laxatives is really useful. These are mostly oil-based pastes that act to lubricate the hairs that are swallowed; reducing the degree to which they clump up, and encouraging them to move on down the intestinal tract. Don't, however, use laxatives regularly without talking to one of our vets first, as excessive inappropriate use can upset the intestines' normal function.

(3) Diet. There are a number of commercial diets now that are specifically designed to help the cat cope with hairballs. They may contain a higher oil content, to help lubricate the hairs; and/or a high fibre content to help move the hairs down the intestine without getting balled up.

(1) Enemas. The most common severe problem caused by hairballs is constipation, as a mass of hair builds up in the colon. Although these can often be shifted with cat laxatives, sometimes they are so stubborn that you'll need to bring them in for our vets to help. In most cases, a simple micro-enema is the sufficient to get things moving again, but in some cases we may need to admit the cat, give them an anaesthetic and then a thorough soapy water enema to wash all the debris and hair out of their large intestine.

Hairballs are usually no more than a minor annoyance. However, for some cats they can be a major problem - fortunately, there are a number of things you can do to help! If your cat is struggling with hairballs, make an appointment to see one of our vets to discuss which option would work best for them.

Neutering

In just 7 years, two cats can (given ideal conditions) produce 40,000 offspring - no wonder, then, that cat rehoming centres are full to bursting. In addition, unneutered cats are prone to a number of annoying and unpleasant habits, which can be easily prevented by neutering. In this guide, we'll look at the advantages of neutering, and then briefly discuss the procedure and aftercare needed.

The main advantage of neutering is, of course, the fact that a neutered cat cannot reproduce. With the world cat population being as healthy as it is, there is no good reason to breed from your cat unless they have excellent genetics that should be preserved. If not, neutering will make your life (and theirs) much less crowded!

As well as rendering them infertile, neutering (unlike a vasectomy or hysterectomy) also stops cats from making sex hormones (oestrogen in the queens, testosterone in the toms). This has the following effects on their behaviour:

(2) Calling - when in season, queens cry out in a high-pitched voice, and roll around on the floor. People often think they are injured or in pain, but actually they're calling for a mate - something they won't do once neutered.

(3) Urine spraying - tomcats tend to mark their territory by spraying foul-smelling urine up every available surface. Once neutered, this hormone-driven behaviour (and also their pungent male odour) will stop.

When your cat is booked in for neutering, it is important to make sure they're properly prepared. In general, this means that if at all possible they should be starved (no food after 6pm and no drink aft midnight the night before). Then bring them down in the morning and we'll admit the, for the day for their procedure.

Spaying - in females, the procedure is a spay. This involves a general anaesthetic and a clipped patch surrounding a small incision (perhaps 1cm long) on one flank. Through this "keyhole" our vets will remove the cat's ovaries and uterus (womb) before tying off the blood vessels and stumps, and then closing the incision with stitches or, sometimes, glue. We would normally expect her to go home the same day.

Castration - for tomcats, the procedure is called castration, and involves surgical removal of both testicles. Once under anaesthetic, we will pluck the hair from his scrotum ("ball sack") and then make two small incisions in it, one on each side. Through these, the testicles are removed and then snipped off, and the cords tied. We often leave the incisions open to drain, but it is sometimes more appropriate to close them with glue or sutures. This is a much easier procedure than spaying (the testicles being much more accessible than a queen's ovaries) and again we'd expect him to go home the same day.

After neutering, your cat will go home with an Elizabethan collar (or cone) on. This is to prevent them from licking at their surgical wounds - licking and nibbling will pull out stitches and will introduce infection. It takes about 10 days for the skin to heal fully, and during this period they must NOT be allowed to interfere with the wounds. At the end of this time, we'll ask to see them again, to remove any stitches and give them a final once-over before signing them off!

Obesity

In the UK, between 40 and 50% of cats are either overweight or obese. It is by far the most common form of malnutrition we see as vets. While we may like to give our pets nice treats and extra meals, we are in fact "killing them with kindness".

(2) Why do cats become obese? Essentially, because we feed them too much. Many cats are by their very nature greedy, and if they ask for more food, all too often we give it too them! Other common problems include us treating them (and feeding them) as kittens even after they've reached their adult size; some people's inability to recognise a cat's healthy weight; increased numbers of neutered cats (who need less calories in their diet than entire cats); and the problem of cats with two or more homes, all of whom feed them.

(3) Why is obesity a Bad Thing? Obesity is a causative factor in a number of serious diseases, including diabetes, arthritis, cystitis (FLUTD), some skin diseases and liver conditions. In addition, it reduces the effectiveness of their immune system, makes them more likely to suffer problems giving birth, puts increased stress on their heart and lungs, and increases the risk of complications if they ever need surgery.

(4) How do we tell if a cat is obese? We use the Body Condition Score system (you can read about it here: http://icatcare.org/advice/obesity-cats). This allows us to asses how much fat the cat is carrying around with them, and score them - in this system, 4-5 is the ideal weight, 1 is skeletally thin and emaciated, and 9 is morbidly obese.

(5) What can we do about it? Essentially, feed less calories and make them do more exercise! Unfortunately, exercise alone doesn't usually resolve the problem, but it does help to increase their muscle tone, heart and lung fitness, and when they've lost the extra weight, they're more likely to keep it off if they are fit.

(6) Surely we can't just stop feeding them?! Definitely not - suddenly starving a an overweight cat can cause liver failure. The best option is to gradually reduce the amount of food they're getting - we usually look for about 1% of body weight loss per week. Some very hungry (or greedy, or manipulative!) cats won't accept this, so it is often better to change to a weight-loss diet, which is designed to fill them up with a low energy density ration - making them feel full, while providing less calories.

(7) How do you make a cat exercise? You could take them for a walk on a lead and harness (and some people do), but expect funny looks! In most cases, encouraging them to play is the better option, usually with chasing or pouncing toys.

Obesity is a growing problem (pun intended) in the UK's feline population. Fortunately, a number of simple, minor changes in the way we interact with our pets can usually bring it under control. If not, give us a call - we run regular weight clinics with our nurses who will be able to help you!

Sexing

It is remarkably hard to tell boy and girl kittens apart - at least until they reach puberty (about six months old) at which point it's usually a bit too late...! In this quick guide, we'll look at some of the simple ways you can tell whether it's a boy or a girl, in a species that's rather shy about disclosing the matter.

(1) Coat Colour. Although coat colour may be indicative, it isn't usually reliable. Yes, ginger cats are more likely to be toms, but there's no reason you can't get a ginger queen, it's just less common. The only exception is with Tortoiseshell cats, which are almost invariably female (the genes for tortie-ness cannot be found in the male). However, there are a few male torties out there due to genetic or chromosome abnormalities, so even with these, it isn't 100%.

(2) Face shape and build. When adult, tomcats usually have a leaner, more muscular build, and a broader, heavier face and skull. However, these features are driven by the sex hormone testosterone, and don't appear until puberty (in the same way that you wouldn't expect a small boy to have a deep voice and a beard!). In kittens before puberty, there is no significant difference in build or facial shape.

(3) Presence of a penis. This sounds the easiest way - however, tomcats have a retractable penis that points backwards underneath the tail... In exactly the same place as the queen's vulva. In both sexes, it just looks like a small hole underneath their anus.

(4) Presence of testicles. By definition, only the boys have testicles! These are located BELOW the anus but ABOVE the penis (bottom hole), and in most kittens will be about the size of a small pea. You can usually feel them by gently feeling the area with your fingers. However, some kittens are a little shy, and pull their testicles back inside, so while the presence of testicles proves that its a boy, the absence doesn't prove that it's a girl. Of course, the older he is, the more likely it is that they'll be obvious, and by 6 or 7 months, 99% of toms will have fully descended and obvious testicles.

(5) The Ano-Genital distance - in other words, the distance between the top and the bottom hole. In general, females have a shorter distance than males, but it can be hard to judge unless you've got a couple of kittens to compare!

(6) The shape of the genital orifice (the bottom hole!). In the females, this is an elongated slit, so when looking from behind they have a round anus and long vulva, like - an i The toms, meanwhile, have two round holes, like :

No one method is ideal; however, by using a combination of different features, it's almost always possible to sex even very tiny kittens with a fair degree of accuracy. If in doubt, come and talk to us and one of our vets or nurses will show you!

Stress

Cats are very prone to becoming stressed - and we now know that stress is a major factor in the development of a range of different diseases and problem-behaviours. In fact, stress and its attendant behaviours may be one of the most common reasons for cats to be rehomed. In this factsheet, we'll try to answer some of the key questions about stress in cats.

(1) How do you know if a cat is stressed? "Acute", or sudden onset, stress or fear is usually easy to recognise - cats tend to crouch down, with their ears back, tail under them, and start shaking. Often, cats will hiss or growl, and they may wet or mess. However, "Chronic", longer term, stress is both more serious and harder to detect. Cats may lose their appetite, or sometimes start gorging. Often, they'll spend more time sleeping or hiding, and they may well increase their marking behaviours - urine spraying, scratching, and face rubbing. Personality changes may also be apparent - increased fussiness, or aggression, for example. Some stressed cats may also seem really confused, unable to decide if they like you or hate you; or appearing to forget the normal routines.

(2) What things make cats stressed? In general, there are three things that cats find stressful. Firstly, changes in the physical environment - so moving furniture, having building work, or replacing carpets or furniture are all difficult for them. Secondly, unexpected events - such as fireworks displays, trips to the vets, or alterations to routine. The most common source of chronic stress, however, is social stress. This typically involves competition between cats - cats often don't get on well with others, and often prefer to be solitary. Being forced to live with other cats, especially unrelated cats, can be inherently stressful (especially if they feel they have to compete for water bowls, food or litter trays). Likewise, new cats coming in (wanted or uninvited) will upset the existing residents. Of course, any human stress will also upset cats, so a new baby, or people moving in or out, will also be a problem.

(3) What can stress lead to? Stress is the main cause of cystitis in cats (Feline Lower Urinary Tract Disorder). It also drives a number of unwanted behaviours, such as aggression, inappropriate urination and defecation, furniture scratching, and urine spraying. Finally, if a cat decides they're too stressed, they'll run away and try to find someone else to live with.

(1) Remove the underlying cause - if possible! If there are several different cats living together, make sure that food and water bowls aren't all together, so the cats don't have to eat together if they don't want to, and make sure there are enough "facilities" for every cat plus one spare. In the case of changes to the human environment it's harder (we're not recommending you bring a child home from school because the cat is stressed, for example!) but where possible, try to minimise the impact on the cat(s).

(2) Use pheromone products. The product which has been proven to work is called Feliway; it contains a synthetic version of Feline Facial Pheromone, the scent that cats use to mark territory. The use of a spray or diffuser is to reassure the cat that they're safe, and it's really effective against all types of stress.

(3) Use calming products. There are a huge range of cat "calmers" on the market; for many, we simply don't know how well they work. There is one product (Zylkene), containing the milk protein casein, that the evidence suggests does work; however, the effect of all of these products are variable and usually quite minor,

If your cat seems stressed, it's really important to check that there isn't an underlying medical problem. If not, you need to try and work out why they aren't happy! Our vets can help, and in severe situations can refer you to a feline behaviourist to help you get it sorted.

Vaccines

Vaccines are the key to protecting cats from infectious diseases such as cat flu, panleukopenia, and even feline leukaemia. These conditions cause untold suffering and even death to unprotected cats, and are all very common in unvaccinated populations.

Vaccines work by "teaching" the cat's immune system how to recognise and fight an infection, without their having to contract it in the first place (and take the risk of chronic long term health issues, severe symptoms or death). Vaccines do not "weaken" the immune system, nor do they "damage" it.

The effect of vaccination is to reduce the chance that a cat develops a disease; if they are unlucky enough to contract it despite vaccination, it will be milder and they won't transmit it to other cats. Some cats, however, cannot receive vaccination (due to certain immune diseases or medications) so vaccinating other cats in the household, colony or area will help to protect these individuals. In this section, we'll look at the different vaccines commonly available in the UK.

(1) Feline Herpes Virus. This is one of the main causes of Cat Flu, and it also attacks the eyes. It's a particularly nasty virus because once infected, most cats will remain carriers for life, as the virus hides away in their nerves even after they have apparently recovered. When they get ill, or stressed, the virus will re-emerge from hiding again. This vaccine is deemed a "core vaccine" that all cats should receive; it only lasts a year, unfortunately, so after the initial course (two injections three weeks apart) they need annual boosters for life.

(2) Feline Calicivirus. This is the other big Cat Flu virus, but can cause more severe disease as well, including ulceration of the mouth and nose, arthritis, abnormal bleeding, and can be fatal. This is a second "core vaccine", again, it requires two injections three weeks apart and then annual boosters.

(3) Panleukopenia. This is also known as Feline Parvovirus, and is a nasty aggressive virus that attacks a cat's bone marrow and gut, causing vomiting and diarrhoea followed by collapse of their immune system. It is the third "core vaccine", and after the initial course, it needs a booster one year later and then boosters every 3 years.

(4) Feline Leukaemia. This virus is spread by close contact (biting, grooming, or sharing food and water bowls) and attacks the cat's immune system. Once infected, the incubation period may last for months or even years, but will eventually destroy their immune system. It can also lead to the development of cancers, particularly leukaemia and lymphoma. The vaccine requires 2 doses 3 weeks apart in kittens, followed by annual boosters.

(5) Feline Chlamydia. This is an uncommon cause of cat flu, and is caused by a bacterium (Chlamydophila felis). Disease is most common in large colonies, especially among breeding groups. The vaccine requires 2 doses 3 weeks apart in kittens, followed by annual boosters.

Vaccines, in most cats, most of the time, are very safe - and certainly, the amount of disease prevented by vaccines is far greater than the amount caused by them. However, they do, very rarely, have significant side effects. The most common noticed effect is minor lethargy for 24 hours after the vaccine; this is exactly what you expect and it means that the vaccine is working, as the immune system meets and analyses the vaccine. Very very rarely, cats may develop allergic reactions, but this is very unusual.

Injection Site Sarcoma is a widely talked about problem, and it is a genuine risk. However, it's really important to remember that it is quite rare, and also that it isn't strictly speaking caused by vaccination (it used to be called Vaccine-Associated Sarcoma, but this is misleading and so the term has been dropped). Injection Site Sarcomas occur even in cats who have never been vaccinated - the tumour is, we think, caused by injection, not by the vaccine that's being injected.

Worming

Cats can suffer from a range of different worms - especially roundworms, hookworms and tapeworms. Small numbers of worms usually don't cause major problems, but if there are too many of them, weight loss, vomiting and diarrhoea may result. Some species of roundworms can even infect humans (especially children), burrowing into the gut, the liver, the brain and the eye. As a result, regular worming is really important!

Most worms in cats are contracted through eating live prey. The major exceptions are the roundworm Toxocara cati (which can infect kittens in their mothers womb, or even through the milk) and the tapeworm Dipylidium caninum (spread by fleas). As a result, even cats who do not hunt are potentially at risk from worms. So, what types of worming products are available?

(1) Herbal and homeopathic remedies. The effects of herbal treatments are weak and unpredictable, while there is no evidence that homeopathic products work at all. As a result, we don't recommend these products for worm control.

(2) Over the counter pet shop and supermarket tablets. These often do kill some worms, but tend to be relatively weak drugs, in low concentrations. Yes, they're cheap, but they don't often work terribly well. They also tend to be big, bulky tablets that need to be pushed down your cat's throat!

(3) Vet and Pharmacy only worming tablets and liquids. The tablets usually contain a mixture of ingredients to kill all the major worm groups, and are generally both safe and effective; while the liquids kill roundworms and are very safe for young kittens.

(4) Prescription-only worming tablets. These are very safe and highly effective, containing several active ingredients to kill all the UK worm types. A few of these products will also kill fleas or other parasites. They can only be purchased from us, or with a veterinary prescription, but they're usually much easier to dose than other tablets, as well as being more effective.

(5) Prescription-only Spot-On products. There are a number of different spot-on wormers. Some just do worms, while others will also kill fleas, mites, and sometimes other parasites; however, most of these combination medications only kill roundworms, not tapeworms too. They can only be purchased from us, or with a veterinary prescription.

Kittens need regular worming against roundworms, but we tend not t worry so much about the other types. From 3 to 9 weeks, they should be wormed roughly every 14 days; and then monthly until six months old. Remember to choose a product that is safe for small kittens, though.

Adult cats should be regularly wormed against roundworms, hookworms and tapeworms. Cats who are active hunters need more regular worming (every 4-6 weeks), whereas those who aren't catching live prey should be treated every 3 months.

Addison's Disease

Addison's disease, also known as hypoadrenocorticism, is a very serious hormone imbalance. Affected dogs often have only very subtle, intermittent signs, until the disease progresses to a life-threatening Addisonian Crisis.

Lack of natural steroid hormones, made in the dog's adrenal glands. Normally, dogs make two types of steroids: glucocorticoids (like cortisol, which help them cope with stress) and mineralocorticoids (which control their salt and water balance). In Addison's, the adrenal glands do not produce enough of these hormones; this may be because of damage to the adrenal glands (Primary Addison's) or, more rarely, injury or disease of other glands in the body that regulate the action of the adrenals, such as the pituitary (or "Master") gland. Occasionally, Addison's can also be the result of excessive steroid medications (we call this "Iatrogenic Addison's", and it occurs because the adrenal glands stop making steroids because we are giving the dog so many; if we reduce the dose too fast, the glands cannot adapt in time).

Much of the time, a dog with Addison's may appear almost normal. However, observant owners will often notice subtle signs such as intermittent vomiting, shaking, muscle weakness or weight loss. These symptoms come and go, and in between episodes may disappear completely. Eventually, however, an affected dog will undergo an Addisonian Crisis, where the symptoms suddenly and dramatically worsen. This is a life-threatening condition, and is usually characterised by acute, severe vomiting and diarrhoea, dehydration, collapse and the rapid onset of shock. Without treatment, it is often fatal. Sadly, in as many as 30% of dogs, the first symptom is an Addisonian Crisis.

There are characteristic changes in the blood salts that are very suggestive of Addison's (especially the ratio between the sodium and potassium). A conclusive diagnosis, however, requires a specialist blood test called and ACTH stimulation test, where a sample of blood is taken, and then your dog is injected with a hormone that should increase the production of cortisol. A second blood sample is then drawn some time later, and if the dog's cortisol level hasn't risen, they are confirmed to have Addison's disease.

Fortunately, once diagnosed, it is perfectly possible to treat Addison's very effectively. In a Crisis, we would put the dog on a drip to correct the salt and fluid imbalances, and give them a steroid injection to help tide them over. Then we would aim to replace the "missing" hormones with specialist steroid medication - either as tablets or a long-acting injection. Regular monitoring is important to ensure that we're giving them the right amount of artificial steroids, but this can normally be done with a simple one-off blood test.

Unfortunately, neither Primary nor Secondary Addison's can be prevented as yet. However, Iatrogenic Addison's can be avoided by only very, very gradually reducing the dose of steroids if your dog has to be on these medications for any reason.

Allergies

Your dog's immune system is a very powerful, very effective defence mechanism - anything that gets into them that it doesn't recognise is attacked and destroyed. However, sometimes the immune system can make a mistake, and respond to a harmless substance in the environment (such as pollen, or a particular type of food, for example). Of course, this cannot be destroyed but the immune system tries really hard to do so! The most common allergen in dogs is thought to be flea saliva (nasty, but not actually harmful!), but they can respond to a wide range of other substances, such as pollen, certain types of protein found in food, storage mites, cleaning products, fabric softener and many more.

Any dog may develop an allergy; however, it is most common for dogs to become allergic early in adult life. It's important to remember, too, that a dog cannot become allergic to a substance until they have been exposed to it on at least two occasions.

The exact symptoms will depend on what part of the immune system has been stimulated; in general, however, most allergies in dogs present with skin symptoms (yes, even food allergies). These include itching, reddening of the skin, hair loss, self-trauma (from the scratching) and secondary infections. In many cases, the skin first affected is that lining the outer ear canals, so dogs with allergic skin disease may initially appear to have an ear infection; the softer skin between the pads on their feet is also commonly affected (when this is involved, we call it "pododermatitis"). In other cases, the allergy may cause a runny, itchy nose ("allergic rhinitis", very like hayfever in humans!), itchy, sore eyes (allergic conjunctivitis) and, rarely, stomach upsets (especially diarrhoea).

There are three approaches to diagnosis. The first is to look at the history - when do the symptoms appear, are they associated with any type of food, or bedding, or environment? Do they only appear after walking under certain trees in the park, or if you've used a particular fabric conditioner? This will often allow us to determine what types of things are causing the allergy, but not always. If not, we can use special tests such as the IgE Blood Test (to look for raised levels of antibody in the bloodstream) or the Intradermal Allergen Test (where we inject certain substances into the skin and then measure the response). These both have strengths and weaknesses, but using a combination of the two we can usually determine the cause of your dog's allergic reactions. The exception is food allergies, as there are no lab tests that can diagnose the condition. In the case of a food allergy, the only way to demonstrate it is to put the dog on an Exclusion Diet, where they eat only either novel foods (that their immune systems have never been exposed to before) or, better, a hydrolysed diet (which is specially formulated so the immune system cannot respond to it). If the symptoms resolve, then we reintroduce one foodstuff at a time until we discover which one is the problem!

The ideal treatment for any allergy is simple - avoid the allergen! In some conditions (like Flea Allergic Dermatitis) this is very doable - it isn't easy but it is possible to eradicate fleas in your house. However, this isn't always practical, so there are other options. The first is medication - there are a range of different medications available to reduce itching and damp-down the immune system's abnormal response. Some are rarely successful (such as antihistamines), some have many side effects (like steroids) and some are very expensive (like ciclosporin), but careful and judicious use of medication can make all the difference to a dog's quality of life. Other possibilities include desensitisation, where we "teach" the immune system to ignore harmless allergens.

There are a wide range of different conditions that can cause anaemia. Broadly speaking, these can be divided up into three areas. Firstly, those conditions characterised by loss of red blood cells. This essentially means blood loss - after a serious injury or wound, the dog will become anaemic because they have lost so many red blood cells. Secondly, diseases that result in the destruction of red blood cells, such as Immune-Mediated Haemolytic Anaemia (IMHA, where the immune system malfunctions and starts destroying red blood cells) and Babesia infection (where a parasite attacked and destroyed the cells). Finally, anaemia can also result if the body isn't making enough - for example, in iron deficiency and malnutrition, chronic, long-term disease, kidney failure, or certain diseases of the bone marrow.

It will of course depend on how severe it is, but generally, the symptoms include pale or white gums, poor exercise tolerance, breathlessness and panting (even after little exercise, or at rest), rapid heart rate and, in some cases, collapse.

Firstly, we'll have to look at your dog's blood. We'll use machines in our lab to count the numbers of red blood cells, but then we'll have to look at the cells under our microscope to try and work out what's going on. It may be necessary to use other, specialist tests (such as the Coomb's Test for immune mediated anaemia), and the blood sample may need to be sent away to an external laboratory. Essentially, we will try and work out what the cause is, so that we can correct it. In a few cases, this can be really complicated, requiring lots of different techniques such as X-rays, ultrasound, additional blood tests, and even bone-marrow biopsies to determine what's going on.

In most cases, once we can determine the underlying cause and stop that, the anaemia will resolve on its own. For example, surgery to close a bleeding wound; medication to kill Babesia parasites, suppression of the immune system in IMHA, iron supplementation if the diet is deficient, etc). However, if the anaemia is very severe, it may be necessary to carry out a blood transfusion from a donor dog to supply extra red blood cells, and buy us time to work. Sometimes, the cause isn't something we can fix, sadly, but in the majority of cases, it can be either fixed or managed with medication.

Anal Gland Problems

Dogs have a pair of anal sacs (often called "anal glands") situated just inside their anus. In a healthy dog, these glands empty every time they go to the toilet - modifying the smell of the dog's faeces so that they can be used to communicate with other dogs (although they all smell equally vile to us!). If these glands become impacted, the secretions inside cannot be squeezed out. As a result, the glands become increasingly full, swollen and uncomfortable.

Any source of a "malfunction" in these glands can lead to problems. Most commonly, the glands fail to empty properly, and so become progressively fuller. The usual causes are an episode of diarrhoea (runny faeces don't squeeze out the glands as effectively as nice solid ones); poor conformation of the glands (which is probably genetic); or an increase in the "thickness" of the fluid (for example, a primary infection, but this is quite rare). Once the gland is impacted and unable to empty itself, secondary infections (which are very common!) occur. This causes the tissue to swell, making the impaction even worse. Eventually, if not expressed, a large and painful abscess will form next to the dog's bottom. When it ruptures, it may ooze pus all over the dog's back end, or burst internally causing severe internal infection.

Any dog may suffer from anal gland problems; however, toy and miniature breeds seem to be at higher risk of abnormally shaped or positioned anal glands. A dog who has suffered from a recent episode of diarrhoea is also at much higher risk.

The first sign is usually "scooting" - rubbing their bottom along the floor, trying to squeeze out the glands. If this is not successful, they may start licking, scratching or biting at their back end. As the glands become more swollen and painful, they may become constipated - they don't want to go to the toilet because it hurts so much!

Very simply - one of our vets will put a finger in your dog's bottom and feel the glands. They'll easily be able to tell if they're swollen, blocked - and if they're painful, your dog will make it very clear...!

The vast majority of anal gland issues are simple impactions, and our vets can easily "squeeze" them out and empty the overfull gland, solving the problem. Occasionally, if the gland is really swollen and inflamed, we may need to give them a short course of antibiotics and anti-inflammatory medication before we can empty them. If this isn't sufficient, the next option is to admit the dog for surgery and surgically drain the glands.

Some dogs are particularly prone to anal gland disease; for these, we'd recommend a small change in the diet (typically, a slight increase in the fibre content) which will allow the passing faeces to squeeze out the contents more effectively. If that isn't enough, we can always surgically remove the glands - this is a pretty complicated operation, and there are possible side effects, but it definitely removed the problem!

Atopic Dermatitis

Also known as "Atopy", Atopic Dermatitis is the second most common allergic disease in dogs, with as many as 15% of dogs affected. It may best be described as a condition where the dog's immune system is hyperactive, giving them a predisposition to developing allergies to multiple different harmless chemicals (or "allergens") in the environment.

Atopic Dermatitis is a genetic condition, although the exact mechanism isn't well understood. It causes a predisposition to developing allergies, and may also make the skin more susceptible to bacterial infections as well. Affected dogs may become allergic to pretty much anything - typically we'd expect to see allergies to grass, tree and other plant pollens, harmless mites (like dust mites or storage mites), as well as foodstuffs (typically protein sources such as beef or soy) and other ubiquitous substances. Occasionally, however, dogs develop much more unusual allergic reactions, for instance to perfume or even rice.

Although Atopy is seen in many breeds, the most heavily predisposed is the West Highland White Terriers. Other breeds with a higher than average chance of developing the condition include Staffordshire Bull Terriers, Boxers, Labradors, Golden Retrievers and German Shepherd. The symptoms always appear first in young dogs - although they may be so mild at first that they aren't noticed or diagnosed until the dog is older.

Atopy results in what we often call "allergic skin disease"; however, it is often more severe and harder to manage than other skin-based allergies. The most characteristic symptom is violent itchiness - often dogs will rub themselves raw trying to scratch - which is usually worst on the face, in the armpits and on the feet. Other symptoms often include repeated "ear-infections" (because the ear canal is lined with skin!), and skin infections ("pyoderma"). The end result is hair loss, reddened, sore or scratched skin, and then infection with pustules forming.

Unfortunately, it is very hard to diagnose atopy conclusively - we generally work by "ruling out" other options! That said, the most powerful diagnostic technique in our armoury is the 2009 Favrot Criteria, which comprise a list of "check-points" we score the dog against. If 5 are met, there's an 80% chance the dog is atopic; if we can match 6, that goes up to 90%. There are different versions of the test, but the criteria usually include: (1) symptoms appearing before three years old; (2) the dog mainly lives indoors but is still affected; (3) the itching improves if steroid medication is given; (4) the itching occurs before the hair loss or rash; (5) the front feet are affected; (6) the centres of the ears are affected, but (7) the edges are not; and (8) the dog's belly is more severely affected than their back.

Sadly, there is no cure for Atopic Dermatitis. However, it can be managed, and there are a wide range of different management options available. The key (if possible!) is allergen avoidance - if your dog isn't exposed to any of the allergens they overreact to, they won't develop symptoms. Allergy Tests (which may use a blood sample or a skin-prick test) can tell you what your dog is reacting to, so you can take steps to minimise their exposure. Skin treatments can be very useful, such as fatty acid sprays and soothing shampoos; but medications are usually essential. The mainstay of management is generally a drug called ciclosporin, which "tunes down" the immune response, but other options include steroids (effective but often with severe side effects if used for too long) and oclacitinib (an anti-itching drug). There's also the possibility in many cases to use immunotherapy with a vaccine that helps to "teach" the immune system that a particular allergen is harmless. In most cases, no one approach will be successful on its own, and managing a dog with Atopy requires experimentation and committment to find the combination of techniques that works for them.

Aural haematoma

An aural haematoma (sometimes called a "cauliflower ear"!) is like a bruise inside the ear. However, because of the location, the blood doesn't dissipate, but forms a large swelling between the layers of skin and cartilage inside the ear flap. In this sense, it's more like a blood blister, causing massive swelling and deformity of the affected ear or ears.

The most common cause is the dog shaking their head excessively - so it's worth thinking of the haematoma itself as a symptom rather than a disease in its own right. The most common causes are ear infections; ear mites; and foreign objects (like grass seeds) in the dog's ears. This makes them scratch at their ears and/or shake their heads, resulting in rupture of the fine blood vessels inside the ear flap.

Any dog may get an aural haematoma, but it is most common (and usually most severe) in dogs with long, floppy ears like Setters or Spaniels. These dogs are more likely to injure their ears when shaking, and are also slightly more likely to suffer from ear problems in the first place.

It depends how severe it is. A mild case may just have a swelling (often reddish or blue-purple) on one part of the ear flap (pinna); whereas a more severe one might result in the whole ear flap blowing up like a balloon. The swelling may be soft or hard to the touch, depending on how recent the bleed is and how much the blood has clotted. Usually, they are uncomfortable initially but soon become painless.

Rapid and effective treatment of ear infections and other diseases will in most cases prevent an aural haematoma from forming in the first place. If you have a dog with itchy ears, regular cleaning with a suitable ear-cleaner will often help too.

Babesia

The Babesia organism is a microscopic parasite a bit like an amoeba. It can only survive and breed inside red blood cells - unfortunately, by living inside them it damages the cells. These organisms are spread by tick bites, and until recently, wasn't found in the UK. Unfortunately, in 2016 the first UK-based transmission of the disease occurred, and it is now thought to be present in our native tick population. The good news is that it can only be transmitted by the Meadow Tick (Dermacentor reticulatus) which is relatively uncommon; the common Sheep Tick (Ixodes ricinus) doesn't carry the disease.

Any dog may be exposed to tick bites if they go outside. The East of England is currently the highest risk area for Babesia, but as the disease will be carried by foxes, it won't remain isolated to this region indefinitely.

The destruction of red blood cells results in anaemia, meaning the dog is unable to transport oxygen around their body successfully. The symptoms do vary a little from dog to dog, but usually involve shortness of breath, lethargy, pale gums, discoloured urine and jaundice.

The parasites are usually visible if we look at a blood sample using a microscope. However, confirmation of the diagnosis requires special stains and so we'll often send a sample away to an external lab for an expert pathologist to confirm.

There are no licensed medications for dogs in the UK to kill the parasites, but we can order them in from other sources if needed. In addition, infected dogs are often very, very sick (some will sadly die even with treatment) so intensive care nursing in the practice is essential if they are going to survive. This may also require a blood transfusion, to replace the infected and damaged red blood cells.

There is no vaccine against Babesia, but the need for a tick is the organism's weak link! Ticks can only transmit the disease after they're firmly secured to your dog (usually 24-48 hours after the initial bite), so an effective tick control product will minimise the risk of infection. If you find a tick on your dog, use a tick hook to remove it (or ask one of our nurses to do it!).

Bladder stones

Bladder crystals form in urine all the time - there are loads of unwanted salts and waste materials in urine which can react together to produce them. Normally, however, they are so small that they don't cause any problems. Sometimes, however, the stones may get large enough to irritate the bladder lining, or even cause a blocked bladder - which is a medical emergency.

There are a number of different types of stones, each with their own set of causes. The more common ones are: (1) Struvite (also called "Triple Phosphate" or "Magnesium Ammonium Phosphate"), which are usually caused by infections, alkaline urine, or sometimes minor dietary imbalances. (2) Cystine, caused by acidic urine, usually only a problem in dogs with a particular genetic disorder. (3) Calcium Oxalate, which may be caused by a genetic disorder, abnormal calcium levels (typically in dogs with a tumour or a parathyroid disease), or antifreeze poisoning. (4) Urate, usually caused by liver disease but is normal in some breeds of dog!

Any dog may develop a bladder stone - most commonly struvite, triggered either by a urinary tract infection or a slight dietary imbalance. Cystine crystals are most commonly seen in breeds such as Newfoundlands, Bassets and Chihuahuas; whereas the gene causing Calcium Oxalate production is more common in the Yorkshire Terrier and Lhasa Apso (among others). Urate crystals almost always mean liver disease - except in Dalmatians, where they are a normal finding! If stones do start to form, they are unlikely to cause a blockage in bitches (whose short, wide urethra or "urine tube", is normally able to expel them). They're much more dangerous in male dogs, where they may block the urethra or become lodged in the penis bone, preventing the dog from urinating.

The most common symptom is cystitis (although this may also be the cause, especially with Struvite!). This typically causes blood in the urine, pain and discomfort on urination, and unusually frequent production of small amounts of urine. If the bladder becomes blocked (a "Urinary Obstruction"), however, the dog will be straining to urinate without passing anything except perhaps a small amount of blood-tinged fluid. Once their bladder is full this will result in uraemic poisoning, causing depression, dehydration, vomiting, collapse and, ultimately, death if not rapidly treated.

We can see the crystals in urine samples when we look at it down the microscope - each type looks different so we can tell which we're dealing with (for example, Urate crystals look like spindles or spiky balls, whereas Struvite forms rectangular crystals sometimes described as being like "coffin lids"). An obstruction, however, we would usually diagnose based on the presenting signs, an overfull bladder, and evidence on blood tests of dangerously high levels of urea in the blood. Sometimes, we can see the stones in the bladder too, with ultrasound or X-rays.

Many stones (Struvite, Cystine and Urate) can be dissolved with a proper diet - we recommend a commercially prepared diet that is formulated not just to prevent them from forming, but to dissolve any stones already present. However, if they are too large, or are causing an obstruction, they usually have to be removed surgically. Many stones lodged in the urethra can be flushed back into the bladder, and then we can remove them easily from there in surgery, but if not, we will have to cut into the urethra to remove them.

Cancer

Cancer, or more properly neoplasia, is an abnormal growth of body cells. It occurs due to damage to the DNA (the "blueprints" or "instructions" that tell the cell how to behave), and especially to those genes which tell a cell when to stop multiplying itself. However, it's important to realise that cancer isn't a single disease - there are thousands of different types. Some are benign (grow but don't spread); some are malignant (invade tissues and spread around the body); and some are intermediate, being invasive but not prone to spreading.

Ultimately, all cancers are due to a mistake when copying the DNA, and is usually due to a random mistake. However, most mutations do not cause cancer - the damaged cell may repair itself (there are enzymes called dismutases whose only job is to fix errors in DNA!); if not, it will usually self-destruct, and if it doesn't, the immune system is very, very good at finding and destroying any mutated cells. However, with so many billions of cells in the body, every now and again, one slips through the net, and grows into a cancer, or tumour. That said, although there is a constant background level of random mutations occurring, some environmental factors can increase the risk - such as radiation, certain chemicals (carcinogens), or because they've inherited defective genes that mean the body doesn't shut down a cancerous growth so efficiently.

In general, cancer is a disease of older dogs - because they've had many more cell divisions, and therefore more chance of a mutation occurring somewhere along the way. There are a few tumours that are predominantly seen in younger animals, but they are relatively uncommon. In addition, there are a few breeds that are at increased risk of cancer (such as Flat Coat Retrievers) because of their genetics. Finally, some animals are immune to some types of cancer - for example, a castrated dog cannot develop testicular cancer because he doesn't have testicles to become cancerous!

Ultimately, it depends on what the cancer is, where it is, and how big it is. For example, a brain tumour may cause seizures or wobbliness, whereas a bone tumour in the leg might cause lameness. In general though, in most cancers you would expect to find a lump or swelling somewhere in the body; weight loss; lethargy and perhaps depression; swelling of the dog's lymph nodes (as the immune system tries to fight it); and occasionally vomiting or diarrhoea.

As usual, it depends on the type of tumour! There are, however, a range of different techniques we can use. In general, blood tests or the symptoms will make us suspicious of a tumour somewhere, and then we go on a "tumour hunt", using our eyes and hands, plus X-rays and ultrasound scans (and sometimes CT or MRI scans) to look for it. Once we've found the lump, we'll often take part of it out and send it to a pathologist to find out exactly what it is (you can't always tell just by looking!) and how best to treat it.

There are four major approaches. (1) a benign, slow growing tumour (such as a lipoma), may simply be left and monitored, especially if the dog is very old and sick and treatment might be more dangerous than it's worth. If it changes behaviour or starts causing a problem, we would, however, reassess it. (2) Surgical removal of the tumour tissue - this is usually the mainstay of treatment, and we'd aim, to remove every single tumour cell. Sadly however, this isn't always possible. (3) Chemotherapy is increasingly available, to prevent regrowth, mop up any stray cells, or slow down the growth of inoperable tumours. Unlike in humans, we use lower doses because keeping the dog comfortable and happy is more important than killing every last tumour cell. (4) Radiation therapy is available at some specialist hospitals to kill the tumour tissue.

Corneal ulcers

A corneal ulcer is a "scratch" on the front of the eye (the cornea being the transparent window in the front). Although the eye is quite capable of healing itself, damage to the cornea can easily become infected, resulting in scarring and, if not rapidly treated, vision impairment.

The most common cause is running through long grass! As the dog runs, the grass whips back in their face and, while the blink reflex is really fast, it isn't always quite quick enough to avoid a grass cut to the cornea. Other common causes include cat scratches (cats always go for the eyes or the nose) and grass seeds and other debris blown on the wind - when running in grass or if dogs stick their head out of a moving car window (which, by the way, it's a really bad idea to let them do!). However, an ulcer doesn't only happen because of trauma - excessive dryness can cause part of the cornea to die and peel away, giving a similar effect. This is seen in dogs with Dry Eye, and those whose eyelids don't meet in the middle properly.

Absolutely any dog may get a corneal ulcer due to trauma. However, dogs with protuberant eyeballs (like pugs) are at highest risk of getting an ulcer because their eyelids don't close properly to protect and moisten the corneal surface. In addition, some breeds (such as Boxers) are at an increased risk of developing an indolent, or non-healing, ulcer if they do get an eye injury.

A corneal ulcer, whatever the cause, usually presents with what we sometimes call the "PLB Triad" - Pain (the eye is obviously sore and often they'll rub at it); Lachrymation (running eyes); and Blepharospasm (the eye is held closed). If it's been there a while, it may become less painful and they'll open it again; you may then see a milky scar on the eye, and blood vessels growing in from the edges to help repair the damage.

We look into their eye with an instrument called an ophthalmoscope, and then put some dye into the front of the eye (usually fluorescein, but occasionally others). These dyes stick only to damaged corneal tissue, and glow when exposed to blue light, so we can see where, and how large, the damaged area is.

The majority of corneal ulcers will heal rapidly with conservative treatment - antibiotic eyedrops to prevent and treat infection, and painkillers to reduce the discomfort and swelling. However, if an ulcer doesn't want to heal (these are called "indolent ulcers"), or starts to get bigger (e.g. a "melting ulcer"), there are a wide range of different treatment options we can use. These include plasma drops (where your dog's own blood is collected, processed, and then applied to the eye to prevent melting or widening of the ulcer) and EDTA drops (same reason). At the same time, a temporary soft contact lens may be fitted to protect the area while it heals. Surgical treatment may also be needed; the most common techniques are a Grid Keratectomy (where the eye is scored under anaesthetic to encourage healing) and Pedicle Flaps (where part of the lining of the eyelid is temporarily attached to the eyeball to help it heal).

Coughing

A cough is a really common symptom; however, it's a symptom not a disease! Coughing is a protective reflex - if anything irritates the airway, the dog will cough to try and clear mucus or debris from their lungs and windpipe. However, many different disease conditions can trigger a cough, so it's always worth getting it checked out.

Any source of irritation to the airway or throat can potentially cause coughing. The most common causes in dogs include: (1) Kennel Cough - a very common infection of the trachea (windpipe) and larynx (voice box); any dog can be infected (although vaccinated dogs are less likely to be ill) and the condition is very contagious. (2) Chest infections and pneumonia are uncommon but do occur in dogs; typically, the dog will be ill in themselves. (3) Heart failure is the commonest cause of coughing in older dogs - caused by an enlarged heart pressing on the trachea, and also an accumulation of fluid in the lungs (pulmonary oedema). (4) Lung tumours can also cause a cough; in dogs (who rarely smoke tobacco!), lung cancer is usually secondary to another tumour elsewhere. (5) Tracheal Collapse Disorder (commonest in toy breed dogs) also causes a characteristic cough, as the windpipe collapses and the dog coughs to try and inflate it. (6) Lungworm (both Dog and Fox Lungworm) can cause coughing, and are being increasingly diagnosed in the UK - although the distribution is rather patchy. (7) Inhalation of food - most common in dogs with laryngeal paralysis, but it can happen in dogs who are just excessively greedy and gobble their food!

Any dog can get a cough! However, heart disease and lung tumours are more common in older dogs, whereas kennel cough seems to be a bit more common in young adults. In addition, a dog who is vaccinated against kennel cough is less likely to develop the disease than one who isn't.

The type of cough can sometimes help to diagnose the cause (although beware of relying on this on its own!). Tracheal collapse usually causes a "honking" type cough, as does Kennel Cough (which may also be described as a barking cough). The cough in Kennel Cough can often be induced by gently feeling the larynx and windpipe in the neck. On the other hand, a cough caused by heart failure tends to be soft and almost apologetic. Other symptoms may also be relevant - for example, a dog with pneumonia will be systemically ill in themselves with a fever, lethargy and depression; whereas dogs with heart failure are more likely to have exercise intolerance.

Physical examination and listening to the chest with a stethoscope will give us a lot of information; however, additional tests are often needed - typically X-rays of the chest and ultrasound scans of the heart. Blood tests for infection, lungworm and heart function are also available.

It depends on the exact cause - for example, a chest infection would need antibiotics, whereas heart failure requires heart medications. We rarely look to suppress the cough itself (because in many cases it is doing its job in removing mucus and infectious material from the chest), but if needed, there are drugs we can use. NEVER use human cough syrups in your dog unless your vet has recommended it!

Cruciate injury

The cruciate ligaments are a pair of structures in the stifle (like our knee) joint of the dog. These (especially the cranial cruciate ligament or CCL) may rupture or break, causing severe lameness and instability in the joint.

In the majority of cases, the rupture is due to degeneration of the ligament that occurs over some weeks or months before they fail completely. However, an otherwise healthy ligament can rupture if overloaded (typically if the dog slips when running and changing direction fast). The exact cause of the degeneration isn't clear, but is probably due to very mild overloading over months or years, and to some extent to the dog's genetics.

The biggest risk factor is obesity - a heavier dog means more load on the ligament and more risk that it will start to degenerate. In addition, certain breeds (such as Labradors) are reported to be at higher risk, and there is a (very slight) increase in risk in neutered dogs compared to entire ones.

Cruciate ligament injuries almost always present with moderate to severe lameness. This may appear suddenly ("acute lameness") or more gradually ("chronic lameness"), depending on the exact type of damage. In addition, you may notice a swelling on the inside of the leg, over the joint (this is sometimes called a "medial buttress").

If the ligament has ruptured, it is possible to move the tibia (shinbone) forward relative to the femur (thigh bone) - this is called cranial draw. When we examine your dog, we may find this sign, but more often we will book your dog in for X-rays; when they're sedated for the X-ray, this cranial draw is much more obvious and will confirm the diagnosis.

In dogs under 8kg, the ligament my heal on its own, given strict rest and a very gradual reintroduction to exercise, possibly involving hydrotherapy. However, in heavier and larger dogs, this is very unlikely, and surgery is usually required. There are several different surgical procedures available, and which we'll use depends on the dog in question and the configuration of their stifle joint. The most common surgical procedures are ligament replacement (like a fabellar suture, where an artificial fibre is used to replace the damaged ligament); tibial tuberosity advancement (TTA and MMP operations, where the front of the tibia is cut and moved, so the cruciate ligament isn't needed any more); and tibial plateau levelling osteotomy (TPLO, where the bone is cut and rotated to stabilise the joint without needing a cruciate ligament). The great advantage of bone surgeries (TTA/MMP and TPLO) are that the dog will be up and able to walk within 24 hours, whereas the ligament replacement surgeries require longer. In all cases, however, the dog will need a very gradual return to exercise, and often physiotherapy or hydrotherapy. Too early return to exercise will result in the repair breaking down, and may result in breaking of the affected leg.

Cryptorchidism

Cryptorchidism, or retained testicles, is one of the most common developmental disorders in male puppies. It is important because once puberty has started, testicles are supposed to be outside the body where they can be kept cool. An overheated testicle inside the body will be infertile (sperm cannot be made at body temperature) and is nearly ten times more likely to become cancerous with a nasty disease called a Sertoli Cell Tumour.

When the puppy is in his mother's womb, his testicles develop next to the kidneys (just like in all mammals, including humans). Once his body decides it is male, a ligament called the gubernaculum pulls the testicles down through the body, through the inguinal canal and into the scrotum - they are supposed to have arrived by a couple of weeks after birth. If this system fails for any reason (usually due to a failure of the gubernaculum to contract fully), the dog will be cryptorchid. It is not uncommon for testicles to be "hidden away" in the inguinal canal before puberty; however, when they grow to adult size at about 6-9 months old, they should drop to and stay in the scrotum - if they're inside the abdomen at this point, they will be too big to fit through the canal.

Simple - affected dogs will usually only have one testicle visible! Occasionally, both testicles are retained, but this is uncommon. If your dog does seem to have only one testicle, it is very unlikely that they genuinely don't have a second one (monorchidism), it's far more probable that the second is hidden away internally.

Physical examination makes it very clear that the scrotum isn't fully occupied! If the second one cannot be located during surgery, it is possible to remove the present testicle and then do hormone tests to see if there is another one hidden away somewhere.

Because of the cancer risk, the retained testicle MUST be removed, and because the condition is genetic, so must the "normal" one. In humans, a procedure called an orchiopexy is used to fix a retained testicle into the proper place in the scrotum; however, because of the heritability of the condition, it is considered unethical to do this in dogs.

Cushing's Disease

Cortisol is sometimes called "the stress hormone", because it is released in the body in times of stress (physical or mental/emotional). It is produced in the adrenal glands, but these are themselves controlled by the pituitary gland, which releases a hormone called ACTH (adrenocorticotropic hormone) telling the adrenals to make more cortisol. If an adrenal gland malfunctions and starts making excessive amounts of cortisol, or if the pituitary malfunctions and releases excessive amounts of ACTH, the result is the same. In most cases, these are due to secreting tumours (about 85% are in the pituitary, so-called Pituitary Cushing's). There is another form of the disease too, called Iatrogenic Cushing's, which is due to excessively high doses of artificial steroids.

The symptoms of any kind of Cushing's are the same; as steroids affect a wide range of different systems, Cushing's can have a wide range of different effects. Common symptoms, however, include: (1) Increased thirst and increased urination. (2) Increased hunger. (3) Hair loss, usually causing bald patches on both flanks. (4) Muscle loss and fat redistribution, resulting in a "pot-bellied" appearance. (5) Increased susceptibility to infection (especially urinary tract and skin). (6) Increased susceptibility to diabetes mellitus. (7) Lethargy. (8) Dislike of heat or hot weather. (9) Increased breathing rate, and often increased panting.

Although the symptoms are quite characteristic, unfortunately there is no test that is 100% accurate in diagnosing Cushing's Disease. The most commonly used tests are: (1) The Urine Cortisol to Creatinine Ratio (UCCR) Test. This is very good as a screening test, but gives lots of false positive results (in other words, you may get a positive result even if the dog doesn't have Cushing's, but it's very unlikely you'll get a negative test if it does). (2) The ACTH Stimulation Test, which works by measuring the response of the adrenal glands to the ACTH hormone. (3) The Dexamethasone Suppression Test (in High and Low Dose forms), which looks to see whether adrenal function is reduced when additional steroids are introduced to the body, which it should be but isn't in Cushing's. The High Dose test can also distinguish between Pituitary and Adrenal Cushing's.

The standard treatment is with medications that temporarily suppress the adrenal gland's ability to make cortisol; with the proper dose, cortisol levels can be managed and kept within the proper range. The active ingredient in these tablets is trilostane, and they are licensed for use in dogs. There is another, related, drug, that permanently destroys the adrenal tissue (mitotane), but this is not licensed and is rarely used, because even a very slight overdose could lead to Addison's Disease.

Cystitis

Cystitis just means "inflammation of the bladder". In dogs, we usually mean a urinary tract infection (bacteria growing in the bladder), but cystitis can also be caused by bladder stones (urolithiasis) or, rarely, a bladder tumour.

By far the most common cause of cystitis in dogs is ascending infection - bacteria that crawl their way up the urethra (the "urine tube") from the outside world. This is much more likely in dogs where the bladder is a less hostile place - for example, diabetic dogs (where the urine contains lots of sugar for the bugs to feed on), those with Cushing's disease (where the immune system is impaired), and those with unusually dilute urine (e.g. Cushing's, Psychogenic Polydipsia, or Diabetes Insipidus). The bacterial infection damages the bladder wall, resulting in symptoms. It is now thought that in some cases, the bacteria may in fact penetrate further, causing a kidney infection. If bladder stones form, there are a number of different types; the most common, struvite, forms because of an infection, whereas other types may reflect an imbalanced diet, or a metabolic defect (e.g. liver disorders leading to urate stones). These stones then rub against the wall of the bladder, causing irritation (just like an infection would). Occasionally, in older dogs, a tumour (or cancer) of the bladder wall may form, also causing the clinical signs.

Female dogs are at a much higher risk of infection, because their urethra is shorter and wider, so bacteria can more easily enter along it. Bladder stones are most often secondary to an infection, but some dogs (such as Dalmatians) are at an increased risk due to certain metabolic differences, and any dog with liver disease is also at increased risk. Bladder tumours, meanwhile, are most common in older dogs.

The symptoms may be subtle or very obvious, depending on the severity and the specific dog! However, they most commonly include: (1) Blood in the urine. (2) Urinating often, but only producing a small amount each time. (3) Pain on urination. (4) Sometimes, incontinence may seem to occur. It is unusual for cystitis to cause a fever or other signs of systemic infection (such as lethargy or loss of appetite); if this occurs, its suggests a more serious condition such as a kidney infection. If your dog is trying to pass urine and isn't able to, they may have a stone blocking their bladder - this is an emergency and needs IMMEDIATE veterinary attention.

Most commonly, cystitis will be diagnosed with a urine sample. The presence of blood suggests significant irritation to the bladder wall, and often we can see (or grow) bacteria from in the urine. A urine sample mustn't be collected from the floor or ground, because we won't be able to check for infection - instead, it should be collected in mid flow (the use of a shallow dish or saucepan may help!). Other tests on the urine may demonstrate crystals (suggestive of stones forming) or abnormal cells (suggestive of a bladder tumour). If stones or a tumour are suspected, X-rays or ultrasound scans may be required to find and localise them.

The vast majority of dogs with cystitis will respond really well to simple treatment with a course of antibiotics. The use of a urine sample to grow the specific bacteria (culture and sensitivity testing) will allow us to choose the most appropriate and effective antibiotic. If there are bladder stones, it may be possible to dissolve them with a special diet; however, some stones are too large, the wrong type, or in the wrong place (for example, blocking the bladder) for this to work, and in these cases they must be surgically removed. Bladder tumours are, sadly, usually inoperable, but there are some medical treatments that can reduce the severity of the symptoms, making the dog more comfortable.

If a dog has a tendency to develop crystals or stones, the use of a special Urinary diet will reduce the chance of any forming. In any dog, making sure that they have free and unrestricted access to water will reduce the risk of cystitis developing, but cannot entirely prevent it.

DCM

DCM stands for Dilated Cardiomyopathy, a form of heart disease characterised by an enlarged but weakened heart muscle. It is most commonly seen in certain breeds, but may also be due to dietary deficiencies. In many cases, DCM leads to abnormal heart rhythms (arrhythmias).

In most cases, it is due to genetic disease, but a taurine-deficient diet can also be a cause. In either case, the heart muscle becomes weaker, resulting in decreased pumping effectiveness. As the muscle becomes weaker, the heart swells up like a balloon, resulting in an enlarged heart with very thin walls (which of course reduces the pumping power even further). The enlargement of the chambers of the heart and thinning of the muscular walls increases the risk of arrhythmias as the "communications system" inside the heart becomes less effective. Eventually, it will inevitably lead to heart failure.

Any dog with a taurine-poor diet (nowadays, this is usually confined to dogs fed a poorly designed home-cooked diet). The more common genetic form is seen primarily in Dobermans, Boxers, Deerhounds, Irish Wolfhounds, Great Danes and other giant breeds, although it is also recognised occasionally in Cocker Spaniels and Portuguese Water Dogs.

Most dogs in the early stages of the disease (the "preclinical phase") show no symptoms. However, this will progress over time to include reduced exercise tolerance, weakness, depression, weak pulses and sometimes a highly irregular or chaotic heart rhythm (atrial fibrillation). Eventually, congestive heart failure will develop with breathlessness, coughing, blue gums, swelling of the abdomen and (sometimes) extremities, collapse and ultimately death. In some dogs (especially Boxers), sudden death may occur without warning. Unfortunately, the disease is always progressive and always fatal - without treatment, death usually occurs in 6-24 months after diagnosis.

Initially, signs of heart disease in a dog of a susceptible breed are highly suspicious; X-rays can identify an enlarged heart but not the exact cause. A confirmed diagnosis therefore relies on echocardiography - an heart scan using ultrasound. With this technique, the swollen, weak heart is clearly visible. In some cases, an ECG may also be useful to categorise the arrhythmia, allowing our vets to determine the best treatment.

The mainstay of treatment is to increase the pumping strength of the heart; and to manage the abnormal heartbeat. The most commonly used drug is pimobendan, which makes the heart muscle work harder, increasing the heart's efficiency. If atrial fibrillation is occurring, the drug digoxin may be used instead, or beta-blockers to slow down the abnormal heart rate. If the dog has gone into congestive heart failure, diuretics ("water tablets") such as frusemide, and ACE inhibitors such as benazepril will help to mitigate the symptoms. Dietary management may also be useful - particularly a low-sodium high taurine and high carnitine diet (as in most commercial cardiac foods). Good medical management will not stop the progression of the disease, but it will slow it down, and make the dog more comfortable.

Dental disease

Dental disease is a catch-all term relating to disease of the teeth and gums. It is very common in dogs, and ranges from mild scale on the teeth to severe periodontal disease that may contribute to kidney or heart disease.

All dogs are at risk from dental disease, but it is often most dramatic in older dogs where the plaque has had years to build up. In addition, miniature and toy breeds are slightly more likely to develop early onset dental disease because they often have abnormalities of the mouth, meaning the teeth are at odd angles and therefore are more likely to build up plaque and tartar.

Initially, the main symptom is halitosis (bad breath!). Over time, this may progress to red, swollen and inflamed gums, loose teeth and pain when eating. In severe cases, dogs may stop eating entirely. In addition, heart disease and kidney failure have both been linked to untreated dental disease.

Simple physical examination is often sufficient, however, dental X-rays are also invaluable. In most dogs, a full examination of the mouth and teeth requires a general anaesthetic so that the gum-lines can be probed (something that isn't possible in very many conscious ones!).

Once dental disease (even severe plaque) has developed, it requires surgical treatment - we call this "a dental", and it's exactly the same treatment as you get when you go to the dentist. The only difference is that we have to use a general anaesthetic. We will carefully examine every tooth, and remove any that are too diseased to survive. Then we'll clean the remaining teeth with an ultrasonic scaler and then polish them to make them smooth. Afterwards, preventative care is all that is usually needed!

Yes, very easily. Although there are a range of "dental chews" available, these are of limited use in most dogs (although they're often better than nothing). The same goes for specialist dental diets; chewing on bones is not reliable and may introduce health problems of its own, so isn't something we'd usually recommend. The most important and effective preventative treatment is tooth brushing - something you should be doing every day. Use a normal tooth brush, and special dog-toothpaste (don't use human toothpaste - the mint burns their gums), and gently brush the teeth at least daily. Mouthwash additives in their water or food will also help slow down the growth of plaque. Regular brushing sounds difficult, but it is the only way to prevent the formation of plaque and subsequent dental disease.

Diabetes mellitus

Like humans, dogs can get diabetes mellitus (sugar diabetes). And like us, it is more likely to occur in the obese than in those of a healthy weight. While the early symptoms may be subtle, it is a potentially fatal condition and can result in severe and life-threatening complications.

Insulin is needed in the body to tell cells to take glucose (sugar) out of the bloodstream and into the cells, where it can be used as fuel. In diabetic dogs, there is insufficient production (often coupled with peripheral insulin resistance), so the blood glucose levels rise uncontrolled. However, the body is unable to use this sugar, and instead turns to burning fats and proteins for fuel. In the short term, this is fine, but if it goes on too long, the dog is at risk of diabetic ketoacidosis, where the blood become acidic and organ systems start to shut down. This is rapidly fatal without immediate emergency treatment.

Any dog may develop diabetes, but it is most common in mid-adult life. Specific risk factors include pancreatitis (because of damage to the pancreas, where insulin is made), pregnancy, some infectious viral diseases, the use of high doses of steroids, Cushing's Disease, and (most importantly) obesity. Certain breeds may be at higher risk, even when all these factors have been accounted for - there is evidence that the Miniature Pinscher, Cairn Terrier and possibly Dachshund and Poodle are at slightly increased risk.

In the early stages, the most common symptoms are increased thirst and increased drinking (this may lead to mild urinary incontinence, especially overnight); increased hunger and weight loss (because they cannot use the sugars in their blood). Affected dogs are also prone to repeated urinary tract infections. Later, if diabetic ketoacidosis occurs, loss of appetite, lethargy, depression, dehydration, vomiting, collapse and ultimately coma and death. All dogs with diabetes, even if it is well controlled, are likely to develop cataracts as well, so it's always worth monitoring their eyesight, or getting the vet to check it over when you come in.

An increased blood glucose level is highly suspicious, as is a high sugar reading in the urine. However, there are other possible causes of these signs (including stress and certain kidney diseases), so the most usual way to confirm the diagnosis of simple or early diabetes is to send away blood for a fructosamine test - this measures the AVERAGE blood glucose level over the previous 2-3 weeks. Another method is to do repeated blood sugar levels over several hours to a day - this is called a blood glucose curve, and will clearly demonstrate persistent high blood glucose levels. In Diabetic Ketoacidosis, the presence of ketones in the blood over a certain level is diagnostic - we often measure this by ketones in the urine (which is equally useful).

Most diabetic dogs can be managed and stabilised effectively, but it is very unusual for it to be possible to manage them without the use of regular daily (or twice daily) injections of insulin. By giving extra insulin at exactly the correct dose, we can "top up" what they're making, and keep their levels in the "normal" range. However, as insulin levels vary over the course of the day, and high levels can be dangerous (leading to a "hypoglycaemic episode" where the dog behaves abnormally, and may become unconscious, have fits, or even die) it is important to match the insulin dose to their feeding times. As a result, a regular, stable routine is VITAL, as is regular monitoring - with a blood glucose meter at home or blood glucose curves. Special diabetic diets also help, by smoothing out the peaks and troughs in blood sugar levels.

Distemper

Distemper is an infectious disease of dogs, also known as "hardpad". It is a very serious condition, and has a mortality rate of approximately 50%; in addition, even dogs who survive and appear to recover may develop symptoms later in life due to the original infection.

Distemper is caused by Canine Distemper Virus - a viral infection closely related to measles. Dogs can contract it by accidentally inhaling or swallowing fluid droplets from an infected dog (produced by the infected dog sneezing them out, but also in the vomit, diarrhoea and urine). Foxes and other wildlife may act as a reservoir for the virus, accounting for sporadic outbreaks in unprotected dogs.

Any unvaccinated dog is at risk from Distemper; however, if the percentage of dogs in the area that are vaccinated is high enough, the risk is relatively low as the virus will not be able to become established in the population. The more people who choose not to vaccinate however, the higher the risk is for everyone's pets.

Initially, there is a fever, which peaks within a week and may not be noticed. However, a few days later it returns, also causing a runny nose and runny eyes; this is rapidly followed by vomiting and diarrhoea, and a thickening of the skin on the footpads (hence "hardpad"). Some dogs will develop infection of the brain and spinal cord, causing wobbliness, paralysis, seizures or a coma, About half of all infected dogs will die or need to be put to sleep, but this may take weeks or even months. In recovered dogs, some will have damage to their eyesight or persistent neurological problems and a certain percentage seem to be fine but will go on to develop "Old Dog Encephalitis", a degenerative brain disease in later life. This usually causes seizures or a "dementia-like" syndrome.

Clinical disease is relatively rare nowadays; however, compatible symptoms in an unvaccinated dog are highly suggestive. Confirmation of the diagnosis usually requires virus isolation in a specialist lab from blood, fluid or tissue samples.

There is no specific treatment available; the standard treatment is supportive (with fluids and symptomatic relief - e.g. antiemetic drugs for vomiting, or anticonvulsants for seizures). Antibiotics are often used to help prevent secondary infections which may in themselves prove fatal. At all times, however, the infected dog must be kept in quarantine, away from other dogs, to minimise the risk of transmission of the infection.

Fractures

Although in popular use a "fracture" means an incompletely broken bone, technically it means ANY break in a bone. These may be complete or incomplete (like a Greenstick fracture), compound (penetrating the skin), comminuted (multiple overlapping fractures, also known as "splintering"), multiple (several non-overlapping fractures) or simple (one clean break that doesn't interfere with any other structures).

90+% of fractures are caused by trauma - being hit by a car, falling from a height, or tripping while running fast are all common causes. More rarely, a fracture may result from an underlying disease process, such as a dietary deficiency (like rickets) or bone cancer.

Any dog can break a bone! Dogs that exercise a lot, or throw themselves around are probably at slightly higher risk, as are very unfit dogs whose musculoskeletal structure is less robust, but the most broken bones are RTAs - road traffic accidents.

The key signs of a fracture are focal pain, swelling, loss of function, and abnormal movement. The majority of fractures are in the legs, where this is often obvious as non-weight bearing lameness (the dog cannot use the limb or put any weight on it). Fractures to other areas may be harder to diagnose, but usually at least three signs will be present. The exception is in incomplete or partial fractures, especially of bones that are naturally splinted (e.g. the toes). These are still very painful, but the dog may be able to use the affected limb to some extent.

The presence of a fracture may be easily obvious (especially if the bone is bending in the wrong place, or a paw is facing the wrong way round!) but to determine exactly what is broken, how and where, we need to X-ray the dog.

It depends what, and where, the fracture is. Some fractures (like incomplete toe fractures, for example) will heal with just a support dressing. Others require surgical fixation, with pins, screws, or even an External Skeletal Fixator (a kind of scaffolding surgically attached to the bone(s) to hold them in place while they heal). It is unusual to be able to effectively cast a fractured limb in a dog, but it is sometimes appropriate, especially in puppies. If a cast is used, it is VITAL to keep it clean and dry, and have it checked regularly for rubbing or sores.

GDV

A GDV occurs when the dog's stomach fills with gas (the "dilation" or "bloat") and then twists (the "volvulus" or "torsion"). This cuts off the blood supply to the stomach and spleen, so these organs start to die; however, it also prevents bloodflow back to the heart, so affected dogs rapidly go into shock. To make matters worse, multi-organ failure then develops, which releases toxic amounts of potassium into the blood, causing the heart to fail. No-one knows exactly why a GDV occurs, but there are certain risk factors we are aware of.

Certain breeds are particularly prone to developing a GDV, usually large and giant breed dogs with a deep-chested conformation (such as Great Danes, German Shepherds, Setters). However, it can occur in any breed. There does appear to be a genetic component, as close relatives of dogs that have had a GDV are at higher risk themselves. Finally, feeding strategies - exercising vigorously immediately after eating or drinking is a known trigger factor.

Typically, the dog first appears restless or uncomfortable; then they start retching. This is usually unproductive, with nothing coming up, but sometimes white froth is seen. They are obviously painful, and the left side of their abdomen (or, later, both sides) may be visibly distended. They will then start showing signs of shock, with pale gums, fast heart rate and panting or laboured breathing. This is followed by collapse and ultimately death.

In many cases, the diagnosis is clear from a simple examination of the dog; however, if there is a question mark over the cause of the symptoms, an X-ray will show the gas-filled, distended stomach occupying the majority of the front half of the abdomen.

THIS IS AN EMERGENCY THAT REQUIRES IMMEDIATE VETERINARY ATTENTION. For first aid, it is sometimes possible for the vet to pass a stomach tube to deflate the stomach; if not, they will often use a wide-gauge needle to let the gas out and buy time. These dogs are highly unstable and require intensive care fluid and electrolyte therapy before they are fit for surgery. Sometimes, heart medications are needed to stabilise the heartbeat as well. Definitive repair requires a surgical procedure called a "gastropexy", where the stomach is returned to its normal position and then fixed to the abdominal wall so it cannot twist again.

Careful management of feeding and exercise will reduce the risk; however, in high-risk breeds that have a close relative who has suffered a GDV, it is possible to carry out a "prophylactic gastropexy", where we go in and fix the stomach in place to prevent a GDV from ever occurring.

Hip dysplasia

Hip dysplasia is a condition characterised by malformation of the hip joints, which leads to rapid degenerative changes (typically early-onset arthritis). It is a genetic condition that used to be present in many breeds; due to the BVA/KC Hip Scoring Scheme it is gradually becoming less common, but it is still one of the commonest causes of hindlimb lameness in dogs.

It is a genetic disorder caused by the interaction of many different genes. In addition, the severity of symptoms will often depend on the environment the dog lives in, and even how they grew up. In most cases, it causes the "socket" (acetabulum) of the hip joint to be too shallow, so the "ball" (the femoral head) keeps popping out. This causes stress on the joint, resulting in further deformity and, ultimately, early onset osteoarthritis in the hips.

It is typically seen in large-breed dogs, but other breeds may also be affected. The highest risk breeds include St Bernards, German Shepherds, Labradors and other Retrievers. The incidence in Setters used to be very high, but a strict breeding programme appears to have reduced it substantially.

Although the condition begins in the immature dog, in many cases symptoms will not be apparent until later (although very severe cases may show as early as 4 months). Classical symptoms include decreased willingness to run, climb stairs and slopes, or jump; difficulty getting up after lying down; and intermittent hindlimb lameness. The condition usually affects both hips (although one may be worse), so it is not uncommon for the dog to be lame on different sides on different occasions, depending on which one hurts more that day. In addition, dogs often adopt a "Marilyn Monroe" type gait, with a narrow-based stance as they try to keep their legs tightly together to reduce the chance of their hip popping out of joint. Other dogs may adopt a "bunny-hopping" or swaying way to get around, because this puts less pressure on the painful joints.

Only by attempting to breed the relevant genetic traits out of breeds - the Hip Scoring scheme is designed to identify those dogs with "bad genes" which should not be bred from, and those with "good genes" that should be prioritised.

Kennel cough

There are a number of different viruses and bacteria that can cause kennel cough. These include Parainfluenza Virus, Canine Adenovirus 2 and the bacterium Bordetella bronchiseptica (first cousin to the human disease, Whooping Cough, which it closely resembles). Whatever the cause, however, the condition is very similar, with inflammation of the larynx (voicebox) and trachea (windpipe) and sometimes the lung tissue (bronchi) as well - as a result it is also sometimes called Infectious Tracheobronchitis.

All dogs are at risk from this highly infectious disease, although vaccinated dogs are less likely to contract it. The infectious agents are carried by dogs, foxes, and even cats and may be transmitted indirectly (e.g. on grass or even clothing that has been exposed).

The classic symptom is a "honking" cough, that is triggered or worsened when the throat is rubbed or stroked. There may also be a mild fever, loss of appetite and lethargy, specially in the early stages; and occasionally a runny or snotty nose. Untreated, the condition will usually self-resolve in 2-3 weeks, but occasionally it can cause more serious effects, such as pneumonia. In this case, the fever will rise, and the dog will become increasingly lethargic. The cough will become moister, and they may struggle to breathe.

Clinical examination is usually sufficient - a cough that can be induced by gently feeling the larynx is pretty much diagnostic! There are also ways to test for the individual agents, typically by taking a swab from the back of the throat and sending it off to a specialist laboratory.

As it is usually self limiting, treatment usually involves rest, quarantine from other dogs (to minimise the risk of spreading it!) and anti-inflammatory medicines to reduce the fever and make them more comfortable. If there is a risk of more severe infection, or an unusually high risk of spreading the infection, antibiotics may be used to kill bacteria and especially the Bordetella. Dogs with pneumonia, however, require intensive care nursing and antibiotics; and may need to be hospitalised and put on a drip of intravenous fluids and medication.

Lungworm

The Dog Lungworm, Angiostrongylus vasorum, is a type of roundworm that (as and adult) lives in the blood vessels around your dog's heart. From here, they lay eggs which travel to the lungs, where they hatch. The baby larvae are then coughed up by the dog, swallowed, and pass out in their faeces. Once out of the dog, they infect passing slugs and snails. These molluscs then spread the infective (L3) larvae in their slime trails wherever they go. When a dog licks a slime trail - or eats a snail or slug - the larvae burrow through their gut wall and travel back to the lungs, ready to start the cycle again.

Lungworm is present throughout the UK; however, its distribution is quite patchy. Some areas see a lot of cases, while others just a mile or two over may see them only very rarely. However, in principle, any dog, anywhere in the UK who ever has access to the outdoors (and therefore to slugs and snails) is potentially at risk.

The most common early sign is a soft, moist cough (as the dog is coughing up the larvae). However, this may progress to heart failure (pale gums, reduced exercise tolerance, even collapse) as the worms build up in the blood vessels. In addition, more worms means more lung damage, so difficulty breathing may also occur. To be able to live in the bloodstream, the worms produce blood-thinners, so abnormal bleeding may also be seen, typically bruising, a rash (on the skin or gums), or bleeding from nose, mouth or bowels. If this stage is reached, affected dogs will usually die if untreated.

The "Gold Standard" test has always been considered finding the worm larvae in the dogs faeces; however, there is now a simple blood test that can be carried out in the practice lab to see if a dog is carrying the worms and therefore may need treatment - whether or not they are showing symptoms yet.

The worms can easily be killed with certain prescription spot-on medications. If there is a severe infection, it may be necessary to give anti-inflammatory drugs as well, to prevent pneumonia happening as the worms die in the lungs. Dogs with heart failure will usually make a complete, or nearly so, recovery once the worms are dead, although they may require oxygen and supportive care in the meantime. Dogs with clotting disorders may require a blood transfusion as well, to replace the clotting factors and the blood that they are losing.

Yes - regular treatment with an appropriate spot-on medication will kill the larvae before they are absorbed. In addition, making sure that your dog doesn't play with slugs or snails; or have any toys or bowls that they might crawl over, will minimise the risk.

Fox Mange

Mange is a serious skin condition, caused by a burrowing mite. It is one of the itchiest skin diseases known, and dogs will often injure themselves trying to scratch it; in addition, the mites are very contagious!

A variety of burrowing mite called Sarcoptes scabiei. This digs into the skin and munches its way through the top layers, causing severe itching. It can easily be transmitted between dogs, cats, foxes and many other animals - and can also infect humans (we call it Scabies if it infects us!). It's called Fox Mange because most cases are associated with dogs rolling in places foxes have been - the fox having left a few mites behind it.

Severe itching, followed by a "bumpy" rash. It usually affects the margins of the ears first, but can be anywhere on the dog's body. The itching is so severe, dogs will often injure themselves trying to scratch, and lose their hair, so it isn't uncommon to see a dog who is largely bald in patches, with an inflamed rash and cuts or scrapes from itching.

Skin scrapes let us collect part of the upper layers of the skin and look at them through the microscope; hopefully, we'll see some mites there! However, because it's so itchy, sometimes there are very few mites to find, so we will often treat a suspicious case even if we can't confirm the diagnosis.

There are a range of prescription spot-on medications and medicated washes (again, prescription only) that rapidly kill the mites. They do not, however, kill the eggs, so usually have to be repeated in 3-4 weeks to break the life-cycle.

Heart Valve Disease

Valve Disease, also known as Endocardiosis or Valve Incompetence, is the most common heart disease in dogs - over 30% of dogs will develop some degree of valve disease by 12 years of age. As a result, it is the most likely diagnosis (although not the only one) in an older dog with a heart murmur.

Inside the heart there are four valves, which work to make sure that blood only flows one-way through the chambers. These are the left atrioventricular (the Mitral or Bicuspid Valve); the right atrioventricular (the Tricuspid Valve); the Aortic Valve and the Pulmonic Valve. Over time, in some dogs, these will start to degenerate, with nodules or bits of scar tissue forming on the edges. This prevents the valve from closing properly, leading to "regurgitation", or leakage of blood. Over time, this reduces the heart's efficiency, leading to heart failure. Although any valve can be affected, the Mitral Valve is the most commonly involved, in roughly 95% of cases.

Any older dog may develop valve disease; however, some breeds of dog are at increased risk. The highest risk is seen in Cavalier King Charles Spaniels, closely followed by Chihuahuas, Cocker Spaniels and a number of other small and toy breeds. Male dogs are at slightly higher risk than females; and the commonest age of onset of heart failure is 10-12 years (although the heart murmur is often detected 2-3 years before that). Cavalier King Charles Spaniels are unusual in that not only is the condition very common, but it develops rapidly, with most affected dogs developing signs of heart failure by 8 years old.

Initially, the only symptom is a heart murmur - an abnormal noise caused by the blood rushing in an unusual direction which the vet will hear when they listen to the dog's chest. As the disease progresses, signs of heart failure will, sooner or later, develop, with reduced exercise tolerance, coughing, panting or difficulty catching breath. Eventually, the heart will fail, leading to profound weakness, pale gums, difficulty breathing, swelling of the abdomen, collapse and (eventually) internal drowning from fluid in the lungs.

In a high risk breed, hearing a murmur is highly suspicious, and may be sufficient to start treatment. However, to confirm the diagnosis, chest X-rays (to demonstrate an enlarged heart) and ultrasound (echocardiography) are required.

The condition cannot yet be cured (although there is experimental heart surgery being tested at the RVC in London). However, there are a wide range of medications available to manage the condition. The most commonly used are diuretics ("water tablets" like frusemide or spironolactone, which prevent fluid build up), ACE Inhibitors (such as benazepril, which improve the dog's quality of life and how well they feel), and drugs to increase the strength of each heartbeat (Pimobendan, which increases lifespan).

Osteoarthritis

Osteoarthritis, also called "Degenerative Joint Disease", is the type of arthritis that older dogs (and people!) get from a lifetime of wear-and-tear. It's probably the commonest single disorder of the older dog, and the commonest threat to their welfare and wellbeing.

As a rule of thumb, there are three causes of osteoarthritis - normal weight bearing on an abnormal joint (e.g. in Hip Dysplasia); abnormal weight bearing on a normal joint (e.g. obese or overweight dogs); and normal weight bearing on a normal joint for an abnormal length of time (e.g. old dogs). Whatever the cause, however, the process is the same - the joint cartilage becomes damaged, leading to inflammation, pain and further damage. At the same time, extra bone forms around the joints to try and stabilise them, but this restricts the range of motion.

The most common early symptom is "stiffness" and a reduced desire for exercise or activity. This may initially be misdiagnosed as simply "getting older" or "slowing down", but it is in fact due to joint pain. It typically progresses to difficulty rising or ascending stairs or slopes, and then definite and obvious lameness (although this is usually present in more than one leg). A characteristic feature is that the lameness or stiffness is usually worst immediately after getting up, and it then decreases or "works off". It is also often worse the day after strenuous exercise.

In many cases, osteoarthritis can be diagnosed simply from the history and a good description of the symptoms. The most useful additional test is often a "Range of movement examination" where the vet will see how far in each direction a joint can be moved without pain - this is usually reduced in patients with advanced arthritis. To fully assess the joint(s), it is necessary to carry out X-rays and look at the bone ends and joint spaces; however, this isn't always appropriate in an old or ill dog.

Strictly speaking, there is no cure for osteoarthritis; however, it is possible to replace some joints - hip and elbow replacements are now fairly common. That said, arthritis is rarely so severe that this is required, at least initially, and it can usually be managed with a combination of techniques. At home, the owners can make the dog's life a lot easier with some simple modification - ramps instead of steps, a comfortable bed to lie on, and keeping their sleeping areas warm. In addition, weight loss can be a very powerful tool in the overweight dog - it is estimated that a reduction of one body condition score point is as effective as a dose of a painkiller! Physiotherapy and hydrotherapy can also be very helpful; however, the mainstay of managing arthritis patients is with medication - usually anti-inflammatory and painkilling drugs. Remember, there are no over-the-counter painkillers for dogs, and human products are often lethally poisonous to dogs. Nutritional supplements (such as glucosamine or chondroitin) are also widely used - the evidence for their effectiveness is weak, but they do seem to help some dogs, especially if given with a large meal (to reduce their breakdown by the stomach acids).

Osteoarthritis will probably develop eventually in most dogs; however, it can be delayed and slowed down with proper care throughout life. This would include weight control, regular exercise, and getting and lameness or other orthopaedic disorders diagnosed and treated as early as possible.

The Canine Parvovirus is transmitted in the faeces of infected dogs. The incubation period of the virus is 7-14 days; once the virus infects a new dog, it attacks both their immune system and their intestines, causing massive breakdown of the gut wall. This allows bacteria from the gut to invade the body, leading to septicaemia ("blood poisoning"). In rare cases, there may also be damage to the heart.

Any unvaccinated dog is potentially at risk. Disease is most commonly seen in puppies between 6 weeks and 6 months of age; up until 6 weeks, they are protected by their mother's immunity ("Maternally Derived Antibodies"). However, in some breeds (such as Rottweilers, Dobermans and possibly German shepherds) this maternal immunity lasts longer - this (counterintuitively) means that the puppies are at HIGHER risk of Parvo, as the maternal immunity may prevent them from responding properly to their puppy vaccines.

The initial symptoms are lethargy and loss of appetite; this is followed by severe vomiting and diarrhoea. The diarrhoea is initially watery but rapidly becomes bloody and develops a foul smell, caused essentially by dead, decaying gut lining. In some cases, chunks of gut lining are passed in the diarrhoea. The dog will now become severely ill, collapse, and will rapidly go into septic shock and die without treatment.

These dogs are incredibly ill and need full intensive care nursing - as well as isolation from all other dogs. High dose intravenous fluids via a drip will help combat the septic shock, and antibiotics will help prevent bacterial septicaemia. Anti-vomiting medications are also invaluable. Immune stimulating drugs (such as interferon), although expensive, can also be very useful in rallying the immune system; however, we would expect at least one in three affected puppies to die despite all treatment efforts.

Yes - there is a highly effective vaccine available (although in certain breeds it may need to be given later than in most dogs). Once the dog has had their puppy course and an annual booster, the vaccine lasts for approximately three years before needing a booster.

In a normal, healthy bitch, after every season her uterus prepares to receive puppies (this is driven by the hormone progesterone), and whether or not she becomes pregnant, the uterine wall will thicken and secrete fluid. As she gets older, this becomes more and more pronounced - we call this Cystic Endometrial Hyperplasia. Once she's decided she isn't actually pregnant (about 2 months after her season), the lining thins down and the fluid is reabsorbed. However, if during this time bacteria can enter the uterus, this fluid is a perfect foodstuff for them, and they rapidly grow and multiply, causing disease. There are two types of Pyo - an Open Pyo (where the cervix remains open, so the pus can drain out of her vagina and vulva), and a Closed Pyo (where the cervix is closed so all the bacteria, pus and toxins are trapped inside). Although both are dangerous, a Closed Pyo is more likely to be fatal, and is harder to diagnose.

Any unspayed bitch - although it may be slightly more common in those who haven't had a litter (although it can happen to any bitch). It usually develops within 3 months of a season, and is more likely in older dogs. Overall, 23% of unspayed bitches can be expected to develop a Pyo by 10 years of age.

A dog with an Open Pyo may just appear a little off colour, with a thick cream, yellow or greenish vaginal discharge. However, more often she will be displaying signs of systemic illness, typically increased thirst and urination, lethargy, and loss of appetite. A Closed Pyo is more dangerous, as there is no discharge to warn you of a problem. She will start out with these non-specific signs, but then rapidly deteriorate and start vomiting, her gums may change colour (to red or possibly pale grey), and her abdomen may seem to swell. Ultimately, she will collapse, go into shock and die.

The treatment of choice is ALWAYS surgical removal of the infected uterus, and this is the only effective treatment for Closed Pyos. In an Open Pyo, it may be possible to use hormones (to make the uterus shrink down and expel the infection) and antibiotics (to treat the bacteria) - however, although many dogs will apparently respond to this treatment, the Pyo will recur after the next season in over 80% of cases.

Vomiting

Vomiting may best be described as the active expulsion of the dog's stomach contents. It's actually a normal function - dogs often eat nasty things, and by vomiting them up they can minimise the risk of serious poisoning. However, it is a very non-specific sign, and can be caused by a huge range of different conditions.

In dogs, the most common cause is "Dietary Indiscretion", also known as "Garbage Gut" - essentially, they ate something rotten and nasty! However, there are a huge range of other causes, depending on whether it is Acute Vomiting (sudden onset) or Chronic Vomiting (it's been going on for a while). The common causes of Acute Vomiting include infections (e.g. gut infections, such as Salmonella or Parvovirus; a response to a high fever; or Pyometra); high worm burdens; reactions to certain drugs (such as NSAID painkillers); poisons (e.g. chocolate); intestinal obstructions; metabolic disorders (e.g. liver disease); pancreatitis; or neurological problems (such as Vestibular Syndrome or travel sickness). Chronic Vomiting, on the other hand, is more likely to be due to more ongoing disease processes, such as kidney failure; SIBO (Small Intestinal Bacterial Overgrowth); IBD (inflammatory Bowel Disease); or tumours in the abdomen or intestinal wall.

Any dog can begin vomiting - it depends what the cause is! In general, in a young dog or one with a habit of eating stupid things (typically but definitely not exclusively Labradors), we'd be leaning towards Garbage Gut or a blockage; whereas in an older dog, kidney disease or tumours are a little more likely.

True vomiting can be difficult to distinguish from regurgitation (where the contents of the oesophagus or gullet simply "flop" out) or even from coughing up a big lump of phlegm. However, vomit when produced has a characteristic acidic smell, and is usually stained yellow or greenish.

Determining the exact cause is really important - while Garbage Gut, for example, can be treated symptomatically, an intestinal obstruction needs urgent surgery. To determine the likely cause, the vets will carefully examine the dog's abdomen, and check their heart and circulatory function. Blood tests can be used to determine how dehydrated (and therefore in danger of complications such as shock) the dogs is, and whether their kidneys or liver are working properly; whereas X-rays and ultrasound scans are used to examine the intestines and internal organs for signs of blockage or malfunction. In some cases, an "exploratory laparotomy" or Ex-Lap is needed - surgery to open the abdomen and actually look to see what's going on.

It depends, of course, on the cause. Simple "Dietary Indiscretion" can usually be managed by starving the dog for 24 hours, providing water little and often, and then reintroducing a bland diet (e.g. boiled chicken and rice, or a commercial intestinal diet). Sometimes, antivomiting drugs may also be appropriate. In other cases (such as Pyometra or kidney failure), the underlying disease must be treated; and in some conditions (like an intestinal obstruction), urgent surgery to remove the blockage is required.

Anaesthesia

Anaesthesia is essentially rendering the dog unaware of the surgery we're performing, in a safe and reversible way. Without it, we wouldn't be able to perform any surgical procedures in a safe and ethical manner - from elective operations like spays and castrations up to major procedures like spinal and orthopaedic reconstruction surgery, we wouldn't be able to perform any of them. We appreciate that an anaesthetic on your dog is a stressful idea at the best of times, so in this factsheet we're going to go through the procedure for you and explain what will happen, and why we do it.

There are other types of anaesthetic (sedation, or local anaesthetic for example), but for most procedures, when we say "anaesthetic" we are talking about a general anaesthetic, where the dog is completely unconscious and unaware of what we're doing. This is in many ways the most useful type of anaesthesia, but there are definite risks associated with it - an anaesthetised dog is so deeply asleep that they cannot always maintain their own breathing rate, heart rate and blood pressure. We have skilled nurses who will be monitoring these parameters, and more, throughout the procedure under the supervision of a vet, so any deviation will be rapidly detected and dealt with. Because of the way the drugs work, any anaesthetic is a balancing act between the dog going too "deep" (and potentially coming to harm), or coming too "shallow" (and potentially running away!). We work to keep them at a level of sleep called "surgical anaesthesia" where they are comfortably asleep but still safe.

Anaesthetics in animals are very, very safe - severe complications in healthy dogs only occur in roughly 0.12% of anaesthetics (so less than 1 in 800), but if there are other disease processes, the dog is very sick, or is elderly, this risk is higher. As a result, we'll usually offer you a blood test, to rule out any underlying conditions such as liver disease, kidney disease, or anaemia, that could adversely affect them under anaesthesia. If we find a problem, it doesn't necessarily mean we can't do the anaesthetic - just that we might need to take some extra precautions.

(1) First of all, they'll be seen either by one of our nurses or one of the vets, who will give them a careful check over for any signs of something that might affect the anaesthetic - for example, a heart murmur or a fever.

(2) Assuming all is well, we'll then give them a premed - a combination sedative and painkiller to help them relax, and minimise any discomfort after their surgery (whatever it is). Using a premed also means that we can use a lower dose of anaesthetic, which reduces the risks.

(4) Once we're all set up for them, one of the nurses will bring them down to the prep area for induction, where we will send them off to sleep. This is usually done with an injection of propofol, but sometimes we may use an anaesthetic gas by face mask.

Once they start to swallow, we'll take out the breathing tube, and then move them to the recovery area where the nurses can keep a close eye on them until they're awake and ready to go home. It's quite normal for a dog to be sleepy or a bit off colour after they get home - it may take them a while to clear all the anaesthetic from their system, especially if they're a bit older - but if you're at all concerned, feel free to call us at any time.

Anaesthesia seems really scary, and people get very worried about the risks. However, except in life-or-death emergencies, we will have carefully prepared, and we wouldn't recommend an anaesthetic unless the risk of not performing the operation was much higher than the risk of carrying it out. All our vets and nurses are fully trained in anaesthesia - because as we're all taught at vet school, there's no such thing as a safe anaesthetic, only a safe anaesthetist!

Breeding

Deciding to breed from your dog is a major decision - there are a lot of things that can go wrong, as well as a lot of important decisions that you'll have to make! It can be difficult, and heart-breaking, and expensive, and rewarding (often all at the same time!), so we've put together this brief guide to help you through the process

Before you decide to breed, it's really important that you're fully prepared. Although actually getting the puppies is the highlight, to get to that stage, there are a lot of preparatory steps. So, before you commit, are you really ready? Is the bitch really suitable to breed from - does she have a good temperament, is she fit and healthy, is she old enough, and can you get all the proper health checks done (such as Hip- and Elbow scoring, and perhaps DNA tests)? Can you find a reputable stud dog, who's had all of his health checks too? Can you assist the bitch when whelping, and help her raise a litter (which could contain 12, or 14, or even more puppies!)? Can you care for the pups (worming, vaccinations, microchipping) and then find them all good, loving homes? Remember, not everything goes according to plan, either - so are you prepared to pay for a caesarean section, if it becomes necessary, bottle rear some or all of the pups, arrange for treatment of any that become ill, and take back any that the new owner decides they don't want?

If the answer to every question is yes, then definitely consider breeding. If, however, you're in any doubt, remember how many dogs there are in pounds up and down the country waiting for a new home. So, if you do decide to breed, you'll need to make sure you're legally covered: if you are producing five or more litters per year, or if your Local Authority think you may be breeding for commercial gain, you will need a breeders license, so check with them before you proceed! In addition, you may want to check what your pet insurance covers - it often excludes any conditions relating to breeding.

Your next step is to get your bitch well and truly checked over by one of our vets - they'll be able to recommend any additional tests you may need. Then you will need to find a stud dog - it's important to check that he's fully tested and healthy as well, and that he isn't too closely related to your bitch (inbreeding is a Bad Thing and we really want to avoid it). If he's not bred before, you might want to consider checking his fertility, especially if you're buying him for stud purposes, or paying a large fee! It's also worth thinking about legal contracts with the dog's owner, to avoid any misunderstandings.

Once she's been mated, we can check for pregnancy from about three and a half weeks with ultrasound, but it isn't really totally reliable until about four weeks - and bear in mind is it NOT possible to count how many puppies there are in an ultrasound scan.

(1) Eclampsia ("milk fever" or hypocalcaemia), which usually occurs at the end of pregnancy or within a couple of weeks of birth. It usually causes shivering and muscle tremors, but can progress to muscle rigidity, seizures and collapse.

(3) Dystocia, or an Obstructed Birth. This occurs when a puppy gets stuck in the birth canal, and is potentially fatal to the puppy and to the bitch. If the bitch is straining without result, or there's a prolonged gap between puppies, contact us for advice straight away.

(4) Weak or sickly puppies. There are a wide range of different causes for weak and puny puppies, but it's always worth getting the litter checked out if you have any concerns. Sometimes, even the smallest runts can be saved with appropriate care, so don't give up until we've had a chance to check them!

Castration

In the wild, all male dogs remain entire and fertile throughout their lives. However, the price of that is an increased vulnerability to some diseases and injuries, and some behaviours that we, as owners, don't find attractive. Neutering is the most common surgical procedure carried out on dogs, and it is now commonplace. If you're trying to decide whether to get your dog "done", it's worth looking at the arguments for it, against it, and then looking at the procedure itself, so that you can make an educated and informed choice.

Let's start with the disadvantages: (1) more or less by definition, a castrated dog's fertility is removed, so you can't change your mind. (HOWEVER, remember that he may still have some sperm "left over" for several weeks after the operation, should he get the chance to "use" them!) (2) There is a very slight increase in the risk of some rare tumours (about 0.4% extra cases of prostate cancer, and 6 extra cases of bone cancer per 100,000 dogs). (3) There is an increased risk of orthopaedic injuries (double the risk of cruciate ligament injuries, possibly an increased risk of hip dysplasia, and because the growth plates in the bones are closed by puberty, they stay open longer meaning an increased risk of certain types of fractures). (4) Weight gain - castrated dogs need less calories than entire ones, so you need to feed them less or they'll put on weight! (5) Risk of surgery - perhaps 0.1% chance of a serious complication.

There are, however, major advantages: (1) No unwanted pregnancies. (2) Reduction in behaviour owners often dislike, such as running off to look for bitches in heat (which increases their risk of road accidents), less sexual behaviour such as masturbation and humping (although it won't be entirely eliminated), and some types of aggression may be reduced in some dogs. (3) No risk of testicular cancer (no testicles = no cancer!) - this affects between 1.5% and 16% of entire dogs. (4) Massively reduced risk of other prostate diseases, hernias and certain cancers of the bottom. (5) Lifespan - a castrated dog will, on average, live 14% longer than an entire one.

Castrating a dog is a very simple surgery (unlike spaying a bitch), because his reproductive organs are conveniently located outside his body. In the procedure, his testicles are removed (so it is NOT the same as a vasectomy, where the testicles remain in situ but the tubes carrying sperm from them are cut) preventing him from making either sperm or testosterone - essentially returning his hormone balance to that of a prepubescent puppy. There is no evidence that dogs miss their testicles once they're gone, nor does castration per se have any effect on their personality or psychological development.

The night before the procedure, it's important he be starved - talk to our nurses who will advise you on how long, but in general, no food after 6pm and no water after 10pm. When you bring him in the next morning, we'll carefully check him over for any problems that might affect his surgery, and then we'll give him a premed injection (a combination of mild sedative to help him relax and a painkiller for afterwards). Then, when we're ready, we will give him a general anaesthetic so he is completely asleep, and pass a breathing tube down his throat to help him breathe. The nurse will scrub the area around his scrotum (ball sack) while the vet scrubs up, and then they'll begin.

It takes perhaps 15 minutes (a very quick procedure!) as a small incision is made in front of the scrotum, and one at a time the testicles are pulled out of this, clamped and cut off. The arteries and spermatic cords are then tied off with dissolvable stitches, and the skin sutured closed. Remember, the scrotum is NOT removed - it is normal for your dog to go home with an empty pouch of skin between their back legs.

Neutering of male dogs does prevent some unpleasant diseases, and increases lifespan by about 14%. However, there are arguments both ways, and you have to make up your mind about your own dog and what would be best for him.

Diet

It's a common misconception that dogs in the wild live off meat - but of course that isn't true! They also eat vegetables and, more importantly, whole animals - meat, bone and internal organs. Putting together a properly balanced diet for a dog isn't actually as easy as you might think, so we've prepared this brief guide to help you!

Although, like us, dogs are omnivores (meaning that they can eat both meat and vegetables), there are some important differences in what they require for a healthy diet. All animals need a number of components in their food, and the correct balance is essential for health.

(1) Energy (or calories). Dogs can get energy from fat, protein or carbohydrate. The amount a dog needs will vary depending on their level of activity, their life stage (for example, puppies and pregnant bitches need more than an older dog).

(2) Protein. An adult dog needs at least 18% protein in their diet, and a growing puppy or a pregnant bitch needs a minimum of 22% (much higher than we do!). However, not all protein sources are equal - animal protein is termed "higher biological value" than plant protein, because it has a healthier mix of essential amino acids for dogs (yes, really - this is why it's really, really hard to formulate a healthy vegan diet for a dog). In addition, dogs need unusually high amounts of the amino acid taurine (unlike humans, who can manufacture their own) in their diet. Without it, they will develop heart disease (cardiomyopathy).

(3) Fats and Oils. Fat provides calories, taste, essential fatty acids and vitamins (A, D, E and K) that are required for healthy skin, coat, hormone production, blood clotting, immunity and many other functions. Insufficient fat in a diet means that firstly, the dog won't want to eat it, and secondly, they will get progressively more ill as their reserves of these vital compounds are depleted.

(4) Carbohydrate - a useful source of energy, but not essential for dogs! The only exception is in a bitch who is producing milk, where she should be getting at least 23% carbohydrate in her diet to produce milk sugar to feed her puppies.

(6) Vitamins and Minerals - these are generally similar to human requirements, although a bitch needs proportionately more calcium when she is lactating (she's likely to have a lot more than one baby to feed!).

It's also important to remember that a dog's nutritional requirements will vary if they are ill or have a chronic health condition - particularly diabetes, urinary crystals, liver disease, kidney disease, heart disease or skin diseases.

In practice, the best approach is usually to feed a reputable, balanced, commercial diet. For example, taurine-deficiency cardiomyopathy is nowadays only seen in those who follow an inappropriate home-cooked diet; whereas calcium imbalances are most common in those who follow a "raw-meaty bones" type diet. That said, it is perfectly possible to formulate a healthy home-cooked diet; however, before you do, make sure you talk to a properly qualified canine nutritionist - don't try to make it up as you go along, or follow a fad internet diet! Our vets will be able to put you in touch with someone if you wish.

Euthanasia

We look after our dogs, let them into our home and our hearts, and love them dearly. In the end, though, all too often it's us who have to decide when to call it a day and let them go. In this short guide, we'll talk about how and when to make that decision, preparing yourself and your family for it, and then the procedure itself.

Sadly, it is quite rare for dogs to die peacefully in their sleep at home; more commonly, they will struggle on, suffering more and more each day. We can (and should) prevent this, and one of the worst mistakes you can make is to leave it too late - a decision you are likely to regret. Making the decision that it's time to put your dog to sleep is never easy - and it shouldn't be.

(3) When they become old, or ill, take out those lists and compare them to their current life. Are they still getting to do things they love? Are they having more good days than bad? Or are they uncomfortable or in pain most of the time; having to constantly do something they hate just to keep going?

When you have made the decision, it is important that everyone in the household is on board with it - if there is significant disagreement, come in and have one of the vets check your dog over and talk to you about the options. If there are children involved, it is all the more important to make sure that they are kept informed - don't try to spare their feelings by making up a story, as it may be harmful in the longer term. You can check out some excellent information on dealing with the issue here: https://www.bluecross.org.uk/pet-loss-support-children-missing-my-friend.

When the time comes, it is best to book an appointment in advance - it means we can make sure that there are both the time and the staff to have everything go smoothly. We may give your dog a sedative, if they seem distressed, and then we will clip a small patch of fur, usually on the foreleg. A veterinary nurse will hug your dog and raise the vein, and the vet will give an injection of an anaesthetic (it's not a poison or anything nasty, just an overdose so they go quietly to sleep and don't wake up). If you would like to stay with them, that's absolutely fine; if not, that's fine too.

Finally, the vet will perform some checks to make sure they've gone. Don't be alarmed if they seem to move, or even gasp after death - this is due to reflexes, it's quite normal, and isn't a sign that anything's gone wrong. There are usually a number of options for dealing with their remains - talk to one of our staff for details.

Although it can be the hardest decision in the world to make, it's even harder to live with the fact that you left it too long, and allowed a beloved pet to suffer unnecessarily. If you need to talk to anyone, please feel free to give us a ring.

Obesity

Obesity is a real threat to dogs (and people!) in the UK, and how better to manage it that with a fitness programme! But do you know how much exercise your dog needs? How should you modify it if they're old, or ill, or very young? In this guide, we'll talk you through the details of best to exercise your best friend.

Dogs need exercise to build and maintain muscle mass, cardiovascular fitness, and to reduce (or at least control) the amount of fat they're carrying around. In addition, exercise will strengthen bone, ligaments and other parts of the musculoskeletal system. A fitter dog is a healthier dog, and is likely to cost you less in vets bills (!), and they will also be a happier dog if they're getting out and about rather than being cooped up indoors all day long.

That said, excessive exercise (especially in an unfit dog) can be harmful - although it is unlikely to lead to a heart attack, it can result in musculoskeletal damage. In particular, we see muscle tears, strains and sprains much more commonly in unfit, overexercised dogs. Usually these are relatively minor, but torn ligaments and tendons can also occur which take much, much longer to heal.

(1) Their breed. Some dogs need more exercise than others - Setters, collies and Spaniels, for instance, need much more activity (to keep them sane if nothing else!) than Greyhounds (for whom a "mad half hour" once a day is usually sufficient). Some dogs, like Labradors, are mentally happy with very little exercise, but need to be encouraged to do more; and others (like Jack Russell Terriers and Chihuahuas) tend to be underexercised (just because they have short legs doesn't mean they don't need as much exercise time as other dogs- it just means they won't cover as much distance in that time!).

(2) That particular individual's fitness; an unfit animal should have a gradually increasing exercise programme, rather than starting cold and doing too much. Likewise, a very fit dog will need more exercise to maintain that fitness.

How hard you exercise your dog is also a bit of a debate - madly running around and chasing toys burns more calories than a gently bimble in the park, but also puts more strain on joints, ligaments and muscles. Overall, a mixture of fast and slow work is probably best for most dogs.

First Aid

It's really scary when you find your dog suddenly injured or hurt - but if you know how to respond immediately (in the minutes before you can get them to us), that can make all the difference to whether they survive or not. So, here's our guide to emergency first aid!

There are a series of basic steps you can take that will allow you to work through most types of injury and give your dog the best chance, If at any stage, however, you're unsure what to do or you're worried about your dog - CALL US!

(1) Are you in any danger? If you become a casualty yourself, you aren't helping your dog! Key things to watch out for are traffic (stop the traffic or at least make sure the road is clear before running to your injured pet); deep water (don't go in out of your depth); electricity (make sure the power is off); and sharp drops or cliffs (don't fall over yourself!). In addition, frightened or painful dogs are much more likely to bite or snap, even without meaning to. So, make sure you can hold your dog's muzzle, and consider using a tie, a belt or a strip of bandage as a temporary muzzle.

(2) Does your dog need CPR? This is the good old ABC - Airway (can they breathe? If not, extend their head and neck and try to clear any obstruction), Breathing (watch for the movement of the chest and feel for airflow from the nose or mouth), and Circulation (feel their heartbeat behind the left elbow, and their pulse in the groin). If they're not breathing or have no pulse, CALL FOR HELP, then start CPR until it arrives. To breathe for your dog, hold their mouth shut and breathe into their nose until you see their chest rise - usually about 10 breaths per minute. If they have no pulse, you must perform chest compressions - just like in humans, 100 compressions per minute.

(3) How bad is the injury? Assuming they aren't actually dying, check your dog over and try to work out what other injuries they have. At this point, concentrate on things that might be fatal - severe bleeding, chest or head injuries, or crushing injuries.

(4) Stop the bleeding. If a major artery is cut, a dog can bleed to death in 2-3 minutes. So, if there is significant bleeding from anywhere, stop it. As a general rule of thumb, if it oozes, it's unlikely to be dangerous; if it trickles, try and stop it, if it gushes or spurts, it needs to be stopped NOW! The best way to stop bleeding is by applying firm pressure to the injury, ideally through a clean cloth or pad to spread the pressure. DO NOT remove your hand or the pressure until 5 minutes after you're certain the bleeding has stopped, or you may pull the clot away and make it start again.

(5) Manage any wounds. Open wounds that aren't bleeding dangerously should be covered with a sterile dressing if possible, and a clean cloth if not; and then left until we can assess them. If there's a foreign object embedded in the wound, DO NOT pull it out unless we tell you to - it may be controlling the bleeding. Burns need to be managed differently - cool the burn with lots of water, and then wrap it in cling film to protect the area.

(6) Stabilise fractures. Most of the time, if your dog has an obviously broken bone, leave it well alone! However, if a limb is wobbling dramatically, you may need to put a splint on it. Don't do this until you've spoken to us, and we'll talk you through the process if needed.

(7) Get them to us so we can work on them! There's a limit to what you can do &ldquo;in the field&rdquo; as it were. The best place for any injured dog is at the surgery, where we have the staff and the equipment to treat them properly. The best thing you can do, therefore, is bring them to us. If they aren't able to walk on their own, try and lift them on a rigid board or plank rather than a bendy blanket (which can worsen spinal injuries) - we'll be able to advise you if necessary.

Flea control

Fleas are the biggest cause of skin disease for UK pets - even now, with so many great products on the market, they're still present living on dogs across the country! There are two reasons they're hard to get rid of - firstly, they can jump from dog to cat to rabbit to human to dog and so evade us; and second, 95% of the fleas aren't living on the animal, but hiding away in your home, waiting for their chance.

(1) Herbal and homeopathic remedies. Herbal flea remedies are notoriously unreliable - what works in one dog fails completely in another. This is particularly true of that old favourite, garlic, which typically results in a flea-ridden dog becoming a smelly, flea-ridden dog! Unfortunately, we cannot recommend homeopathic remedies, as there is no evidence that they are effective against fleas.

(2) Over-the-Counter Flea Drops and Powders. There are a wide range available, at very cheap prices. However, remember that, with medicines as with everything else, you get what you pay for. Over-the-counter products from pet shops or supermarkets are unlikely to be as effective as prescription-only or vet/pharmacist only products - not least because these often do not need to prove their effectiveness.

(3) Prescription Flea Spot-Ons. There are a lot of different spot-on medications, containing different ingredients, but they all work by killing the fleas. The most common contain fipronil, selamectin or imidacloprid, but there are others as well. These medications have to prove their effectiveness before being given a license; however, remember that many aren't waterproof and will wash out if you give your dog a bath or they regularly swim. On the other hand, these are often effective against other parasites, such as ticks or mange mites. Of course, you can only get these from, or with a prescription from, your vet.

(4) Flea Tablets. There are a number of different brands, and different active ingredients available now; these have the advantage that they cannot be washed off, and some will also treat for ticks as well. They do still need to be repeated periodically though - like all medications, they won't last for ever! Some over-the-counter tablets only last for 24 hours, whereas some of the prescription-only products may last 3 months.

(5) Medicated Collars. Available in prescription-only and over-the-counter forms, once again, the prescription-only or vet/pharmacist only forms are the most effective. These ones kill adult fleas, and may also treat or repel ticks, mosquitoes or even sand-flies.

(6) Environmental Control Medications. Some flea products contain ingredients called Insect Growth Regulators, that effectively put the fleas on the pill so they only lay non-viable eggs. Others contain ingredients that directly act to kill flea larvae in the environment. These are invaluable for preventing a household infestation, but may not completely control one that is already established (or at least, not quickly).

(7) Environmental insecticides. These can be sprayed onto soft furnishings throughout the home to kill larvae and eggs. Bear in mind that, although generally effective, you need to follow the label instructions, as some can be toxic if you overdose! In addition, flea pupae are immune to any form of chemical warfare we can practically employ!

(8) Vacuuming. Yes, the humble vacuumed cleaner is your secret weapon in the war on fleas! It will suck up eggs, and the flea-droppings that the larvae feed on, but more importantly, it will stimulate the pupae to hatch, releasing new hungry adults. In this state, they an easily be killed with an insecticide spray!

No one medication or intervention will control a severe infestation - instead, you'll need to attack them on several fronts, usually with an adult-killing medication, and environmental control spray or medication, and spotless hygiene in the home. If you need advice, feel free to call us!